Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 12699 | PR |
NPI | 1013979723 |
---|---|
Provider Name | Dr. Julio Santory -Ortiz |
First Address | Juncos, PR 00777-1454 |
Second Address | Las Piedras, PR 00771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 21/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H54693 | (02) |