Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN15279 | FL |
NPI | 1083637334 |
---|---|
Provider Name | Dr. Rigo Cornejo |
First Address | Winter Haven, FL 33880-4145 |
Second Address | Winter Haven, FL 33880-4145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 21/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U81777 | (02) |