Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 10770 | PR |
NPI | 1104868439 |
---|---|
Provider Name | Dr. Vilma Cora |
First Address | Bayamon, PR 00957 |
Second Address | Rio Piedras, PR 00921-4237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 03/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10770 | STATE MEDICAL LICENSE (01) | PR |