Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 19700 | PR |
NPI | 1063933158 |
---|---|
Provider Name | Joel Corchado |
First Address | Trujillo Alto, PR 00977 |
Second Address | Trujillo Alto, PR 00976-5948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2017 |
Last Update Date | 29/06/2017 |