Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 864 | PR |
NPI | 1013341718 |
---|---|
Provider Name | Miss Widna Del Moral Espada |
First Address | Patillas, PR 00723 |
Second Address | Patillas, PR 00723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 29/08/2013 |