Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 000724 | PR |
NPI | 1003198755 |
---|---|
Provider Name | Lourdes M. Fuentes Rivera |
First Address | Bayamon, PR 00959-0000 |
Second Address | Bayamon, PR 00959-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2011 |
Last Update Date | 19/09/2011 |