Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 0101056752 | VA |
Y | 207K00000X | Allergist & Immunologist | 20422 | WV |
NPI | 1205885308 |
---|---|
Provider Name | Isabel Cristina Deltoro Gordinho |
First Address | Beckley, WV 25801 |
Second Address | Beckley, WV 25801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 10/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000385736 | BLUE CROSS BLUE SHIELD (01) | WV |
005806437 | (05) | VA |
0070431000 | (05) | WV |
282724 | BLUE CROSS BLUE SHIELD (01) | VA |
G65265 | (02) |