Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 9871 | PR |
NPI | 1033116306 |
---|---|
Provider Name | Dr. Leonardo J Campiz Jimenez |
First Address | San Juan, PR 00926-6013 |
Second Address | San Juan, PR 00918-3733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F99367 | (02) | PR |