Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | 704 | PR |
NPI | 1144373853 |
---|---|
Provider Name | Mrs. Angelita Martinez |
First Address | Ponce, PR 00730-3772 |
Second Address | Ponce, PR 00730-3772 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 03/02/2014 |