Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 268330 | MA |
NPI | 1669824389 |
---|---|
Provider Name | Gisele Portes Cruz |
First Address | Boston, MA 02115 |
Second Address | North Weymouth, MA 02191-2218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2016 |
Last Update Date | 16/08/2016 |