Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 16147 | PR |
NPI | 1003808742 |
---|---|
Provider Name | Elba Rosa Martin Reyes |
First Address | Guaynabo, PR 00966 |
Second Address | Guaynabo, PR 00968-4484 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16147 | MEDICAL LISENCE (01) | PR |