Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 538 | PR |
NPI | 1104001700 |
---|---|
Provider Name | Mr. Angel Luis Laureano-Vega |
First Address | Vega Alta, PR 00692-3040 |
Second Address | Vega Alta, PR 00692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 02/01/2008 |