Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | PENDING | MA |
NPI | 1538650171 |
---|---|
Provider Name | Laura Ortiz-Teran |
First Address | Concord, MA 01742-1947 |
Second Address | Boston, MA 02115-6106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 18/05/2018 |