Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 12865 | PR |
Y | 2084N0400X | Neurologist | 12865 | PR |
NPI | 1013984004 |
---|---|
Provider Name | Dr. Mari Tere Garcia-Rondon |
First Address | Mesa, AZ 85274 |
Second Address | San Juan, PR 00926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G79668 | (02) | PR |