Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2074 | PR |
NPI | 1497744072 |
---|---|
Provider Name | Dr. Lidia M Guerrero-Rodriguez |
First Address | San Juan, PR 00929-0736 |
Second Address | San Juan, PR 00924-4605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 31/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02074 | PROFESSIONAL LICENSE NUM (01) | PR |