Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 210129 | NY |
N | 2084N0400X | Neurologist | 210129 | NY |
Y | 2084N0402X | Child Neurologist | 210129 | NY |
NPI | 1326003237 |
---|---|
Provider Name | Gustavo A Charria-Ortiz |
First Address | San Antonio, TX 78207-3255 |
Second Address | San Antonio, TX 78207-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 30/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H23609 | (02) | FL |