Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 12744 | PR |
NPI | 1053394734 |
---|---|
Provider Name | Dr. Myriam Amaro De Jesus |
First Address | San Juan, PR 00921-2308 |
Second Address | San Juan, PR 00921-2308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 08/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12744 | LICENCIA (01) | PR |
BA58652627 | DEA (01) | PR |