Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0059 | PR |
Y | 222Z00000X | Podiatrist | 0059 | PR |
NPI | 1023048535 |
---|---|
Provider Name | Dr. Ricardo F Jaen |
First Address | Carolina, PR 00984 |
Second Address | Carolina, PR 00983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 05/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U53065 | (02) |