Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 10224 | PR |
NPI | 1134211121 |
---|---|
Provider Name | Mr. Fernando Luis Zayas Torres |
First Address | Cidra, PR 00739 |
Second Address | Cidra, PR 00739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F47553 | (02) | PR |