Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 49 | PR |
NPI | 1144732561 |
---|---|
Provider Name | Dr. Katherine Smith |
First Address | Toa Baja, PR 00949-9745 |
Second Address | Gurabo, PR 00778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 25/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49 | PUERTO RICO LICENSE TO PRACTICE NATUROPATHIC MEDICINE (01) | PR |