Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 12083 | PR |
NPI | 1245248566 |
---|---|
Provider Name | Manuel A Badillo Collazo |
First Address | San Juan, PR 00926 |
Second Address | San Juan, PR 00921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 09/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G41199 | (02) | PR |