Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 9300588 | NC |
NPI | 1114991098 |
---|---|
Provider Name | Dr. Maria-Dorina Cruz Sevilla |
First Address | Winston Salem, NC 27106-3410 |
Second Address | Winston Salem, NC 27106-3410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8975331 | (05) | NC |
G00575 | (02) | NC |