Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3245 | PR |
NPI | 1063863835 |
---|---|
Provider Name | Jennifer Lithgow |
First Address | San Juan, PR 00927 |
Second Address | Mayaguez, PR 00680 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 28/06/2019 |