Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 11676 | PR |
N | 208000000X | Pediatrician | 11676 | PR |
NPI | 1639138332 |
---|---|
Provider Name | Dr. Mario E Paulino |
First Address | San Juan, PR 00936 |
Second Address | San Juan, PR 00912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 16/11/2016 |