Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 16931 | PR |
N | 208D00000X | General Practice Physician | 16931 | PR |
NPI | 1942487855 |
---|---|
Provider Name | Dr. Melba Iris Antommarchi |
First Address | Guayanilla, PR 00656-3999 |
Second Address | Guayanilla, PR 00656-3999 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1878 | (02) | PR |
1878 | (05) | PR |