Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 11177 | PR |
NPI | 1063585024 |
---|---|
Provider Name | Marisol M Mubarak Perdomo |
First Address | San Juan, PR 00926 |
Second Address | San Juan, PR 00907-1567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0500133 | HUMANA HEALTH PLANS (01) | PR |
217023 | PREFERRED HEALTH (01) | PR |
600108 | MEDICARE Y MUCHO MAS (01) | PR |
83360 | TRIPLE S (01) | PR |
F59459 | (02) | PR |