Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 041307 | NY |
NPI | 1356980403 |
---|---|
Provider Name | Johanne Paylado Ricarte |
First Address | Auburndale, NY 11358-3934 |
Second Address | Bronx, NY 10461-5707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2020 |
Last Update Date | 06/01/2020 |