Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 7863 | PR |
NPI | 1053370130 |
---|---|
Provider Name | Joham Senior Marino |
First Address | Bayamon, PR 00960-0365 |
Second Address | Bayamon, PR 00960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 17/11/2010 |