Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 21880 | PR |
N | 207NS0135X | Procedural Dermatology | 21880 | PR |
N | 208D00000X | General Practice Physician | 14906I | PR |
NPI | 1144776865 |
---|---|
Provider Name | Marely Santiago Vazquez |
First Address | San Juan, PR 00936-5067 |
Second Address | San Juan, PR 00921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1144776865 | (05) | PR |