Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist | 1109 | PR |
NPI | 1154667434 |
---|---|
Provider Name | Mrs. Ada M. Padro |
First Address | Hormigueros, PR 00660-5337 |
Second Address | Hormigueros, PR 00660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2012 |
Last Update Date | 14/12/2012 |