Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 17514 | PR |
NPI | 1013150895 |
---|---|
Provider Name | Frances Mary Rodriguez Matos |
First Address | Penuelas, PR 00624-0966 |
Second Address | Penuelas, PR 00624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2009 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013150895 | (05) | PR |