Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21162 | PR |
NPI | 1013487974 |
---|---|
Provider Name | Ivonne Trujillo-Esquilin |
First Address | Coamo, PR 00769 |
Second Address | Coamo, PR 00769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2018 |
Last Update Date | 04/12/2018 |