Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 236579 | NY |
Y | 2088P0231X | Pediatric Urologist | 236579 | NY |
NPI | 1003076753 |
---|---|
Provider Name | Jimena Cubillos |
First Address | Rochester, NY 14642-0001 |
Second Address | Rochester, NY 14642-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 02/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03123080 | (05) | NY |