Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3244 | PR |
NPI | 1033563150 |
---|---|
Provider Name | Mairym Y Delgado Roman |
First Address | Guaynabo, PR 00969-4306 |
Second Address | San Juan, PR 00918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 08/08/2019 |