Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 11772 | PR |
NPI | 1265511158 |
---|---|
Provider Name | Jesus Zayas |
First Address | Guayama, PR 00785-0024 |
Second Address | Guayama, PR 00784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |