Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 19570 | PR |
NPI | 1336566744 |
---|---|
Provider Name | Giannina Coppola-Fasick |
First Address | San Juan, PR 00927-6225 |
Second Address | Carolina, PR 00987-7102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038915800 | (05) | PR |