Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 7691 | PR |
NPI | 1619081478 |
---|---|
Provider Name | Dr. Roberto P. Bordewyk |
First Address | Guaynabo, PR 00969 |
Second Address | San Juan, PR 00921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |