Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0037 | PR |
NPI | 1043219801 |
---|---|
Provider Name | Dr. Sylvette G. Peterson |
First Address | Moca, PR 00676-0717 |
Second Address | Aguadilla, PR 00603-5970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T-81945 | (02) | PR |