Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 149 | VI |
NPI | 1003913534 |
---|---|
Provider Name | Jose Manibo |
First Address | Christiansted, VI 00821-1593 |
Second Address | Christiansted, VI 00823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G42978 | (02) | VI |