Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 3758 | PR |
NPI | 1548241052 |
---|---|
Provider Name | Miss Rita Maria Diaz |
First Address | San Juan, PR 00919 |
Second Address | San Juan, PR 00919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 08/07/2007 |