Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14482 | PR |
NPI | 1043206246 |
---|---|
Provider Name | Dr. Nestor R. Frontera-Tacoronte |
First Address | Ponce, PR 00780-2033 |
Second Address | Guanica, PR 00653-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 23/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I11259 | (02) | PR |