Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 19208 | PR |
NPI | 1003288143 |
---|---|
Provider Name | Dr. Yadira Dominguez Vazquez |
First Address | Bayamon, PR 00957 |
Second Address | Bayamon, PR 00957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |