Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | ||
Y | 156FC0801X | Contact Lens Fitter |
NPI | 1902040876 |
---|---|
Provider Name | Mrs. Aguedita Reyes Reyes |
First Address | Bayamon, PR 00956 |
Second Address | Bayamon, PR 00961-4538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 23/04/2009 |