Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 35681-R | PR |
NPI | 1013417005 |
---|---|
Provider Name | Evelyn Del Mar Vallejo Calzada |
First Address | San Juan, PR 00936-5067 |
Second Address | San Juan, PR 00921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2018 |
Last Update Date | 18/08/2021 |