Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15555 | PR |
NPI | 1013947423 |
---|---|
Provider Name | Grisselle Enid Ortiz Rivera |
First Address | Ciales, PR 00638-0036 |
Second Address | Manati, PR 00674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |