Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2366 | PR |
NPI | 1114146362 |
---|---|
Provider Name | Dr. Lizbeth Marie Colon-Deglans |
First Address | Carolina, PR 00985 |
Second Address | Carolina, PR 00985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |