Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 6813 | PR |
NPI | 1033421128 |
---|---|
Provider Name | Dr. Rosa B. Licha-De-Becerra |
First Address | San Juan, PR 00926-6047 |
Second Address | San Juan, PR 00926-6047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 06/07/2010 |