Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 12836 | PR |
NPI | 1275541534 |
---|---|
Provider Name | Grisselle Perez Santiago |
First Address | San Juan, PR 00926-7100 |
Second Address | Bayamon, PR 00959-5045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G74204 | (02) | PR |