Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15185 | PR |
NPI | 1013000181 |
---|---|
Provider Name | Mr. Pedro Antonio Mariani Molini SR. |
First Address | Cabo Rojo, PR 00623 |
Second Address | Boqueron, PR 00623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 29/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I25555 | (02) |