Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 30988 | IA |
N | 111NI0900X | Internist | 30988 | IA |
Y | 207RG0100X | Gastroenterologist | 30988 | IA |
NPI | 1003859877 |
---|---|
Provider Name | Dr. Victor R. Mujica |
First Address | Waterloo, IA 50702-5063 |
Second Address | Cedar Falls, IA 50613-2382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1152520 | (05) | IA |
G48546 | (02) |