Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 53086 | KY |
NPI | 1023456043 |
---|---|
Provider Name | Liege Isabel Diaz Urrutia |
First Address | Tampa, FL 33606-2355 |
Second Address | Ashland, KY 41101-2879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 02/09/2020 |