Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DN16121 | FL |
NPI | 1144320474 |
---|---|
Provider Name | Luis F Alicea |
First Address | Orlando, FL 32819-8000 |
Second Address | Orlando, FL 32819-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/08/2011 |