Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 848 | PR |
NPI | 1063786937 |
---|---|
Provider Name | Mrs. Emma Ines Rosario |
First Address | San Juan, PR 00927-4943 |
Second Address | San Juan, PR 00927-4943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2012 |
Last Update Date | 13/11/2012 |