Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 22455 | PR |
NPI | 1033888540 |
---|---|
Provider Name | Karina Ortiz Del Valle |
First Address | Caguas, PR 00725 |
Second Address | Caguas, PR 00725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2021 |
Last Update Date | 23/09/2021 |