Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 12609 | NC |
NPI | 1144547167 |
---|---|
Provider Name | Mr. Nylton Tuibuen Basco |
First Address | Coral Springs, FL 33067-3248 |
Second Address | Coral Springs, FL 33067-3248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 29/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B200638761050 | DRIVER'S LICENSE (01) | FL |