Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21982 | PR |
NPI | 1043826142 |
---|---|
Provider Name | Karina Mariel Garcia Collazo |
First Address | Manati, PR 00674-1334 |
Second Address | Manati, PR 00674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |