Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 19460 | PR |
NPI | 1013367275 |
---|---|
Provider Name | Dr. Xavier Ivan Albino Flores |
First Address | Mayaguez, PR 00682-6274 |
Second Address | Ponce, PR 00717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 30/08/2016 |