Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 070-R | PR |
NPI | 1134893373 |
---|---|
Provider Name | Dr. Tessie Harfuch Capdevila |
First Address | San Juan, PR 00927-5128 |
Second Address | San Juan, PR 00921-0092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2021 |
Last Update Date | 02/08/2021 |