Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 21787 | PR |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 21787 | PR |
NPI | 1073033999 |
---|---|
Provider Name | Magda Liz Reyes Oliver |
First Address | Vega Baja, PR 00693 |
Second Address | San Juan, PR 00921-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 31/08/2021 |