Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 643 | PR |
NPI | 1033608492 |
---|---|
Provider Name | Mr. Jaime Cruz |
First Address | Lares, PR 00669 |
Second Address | Barceloneta, PR 00617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 01/05/2018 |