Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 3776 | PR |
NPI | 1013182211 |
---|---|
Provider Name | Dr. Luz Magali Pena |
First Address | San Juan, PR 00902-3736 |
Second Address | San Juan, PR 00901-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 28/04/2008 |