Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 135 | PR |
NPI | 1144363714 |
---|---|
Provider Name | Miss Myriam M Santiago |
First Address | Ponce, PR 00730-3761 |
Second Address | Ponce, PR 00730-3728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |