Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 691 | PR |
NPI | 1104033869 |
---|---|
Provider Name | Irasema Laboy San Miguel |
First Address | Cidra, PR 00739 |
Second Address | Cidra, PR 00739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |