Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 854 | PR |
NPI | 1043392053 |
---|---|
Provider Name | Dr. Marcos F. Vecchini |
First Address | San Juan, PR 00918-8001 |
Second Address | San Juan, PR 00918-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
854 | DENTAL LICENCE (01) | PR |
AV7285504 | DEA LICENCE (01) | PR |