Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 9035 | PR |
NPI | 1346436607 |
---|---|
Provider Name | Jose A Cebollero Marcucci |
First Address | Guayama, PR 00785-2039 |
Second Address | Guayama, PR 00784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 26/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E77313 | (02) | PR |