Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 7093 | PR |
NPI | 1689755126 |
---|---|
Provider Name | Fernando J. Cabrera Delgado |
First Address | Bayamon, PR 00961-6919 |
Second Address | Bayamon, PR 00961-6910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
99299 | TRIPLESSS (01) | PR |