Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 11246 | CT |
Y | 213EG0000X | General Practice | 11246 | CT |
NPI | 1003075847 |
---|---|
Provider Name | Giuliana Novoa-Ordonez |
First Address | Bridgeport, CT 06608-1913 |
Second Address | Bridgeport, CT 06608-1913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 22/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11246 | STATE LICENSE (01) | CT |