Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 278713 | MA |
NPI | 1033606249 |
---|---|
Provider Name | Monica Rosales Santillan |
First Address | Boston, MA 02215-5400 |
Second Address | Boston, MA 02215-5400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 25/03/2020 |