Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 12433 | PR |
NPI | 1073590691 |
---|---|
Provider Name | Dr. Omar A Gonzalez Yanes |
First Address | San Juan, PR 00936-4792 |
Second Address | San Juan, PR 00917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 14/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H45072 | (02) | PR |