Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 0101262137 | VA |
Y | 111NI0900X | Internist | 0101262137 | VA |
NPI | 1003175142 |
---|---|
Provider Name | Mariana Gomez De La Espriella |
First Address | Pearisburg, VA 24134-2471 |
Second Address | Pearisburg, VA 24134-2471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2012 |
Last Update Date | 14/07/2021 |