Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15546 | PR |
NPI | 1013119304 |
---|---|
Provider Name | Dr. Yudit Maytee Brito Pequera |
First Address | Carolina, PR 00979-4027 |
Second Address | San Juan, PR 00917-5030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15546 | LICENSE # (01) | PR |
15799 D.M.-O (P-R) | LOCAL (01) | PR |
BB9253662 | DEA REG. NO. (01) | PR |