Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 8133 | PR |
NPI | 1619050911 |
---|---|
Provider Name | Maria Milagros Pietri |
First Address | San Juan, PR 00927-6351 |
Second Address | Bayamon, PR 00956-4816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D95887 | (02) | PR |