Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 17279 | PR |
NPI | 1013166107 |
---|---|
Provider Name | Dr. Marjorie Acosta-Guillot |
First Address | Toa Baja, PR 00949-2814 |
Second Address | Toa Alta, PR 00953-2220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 07/08/2020 |