Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1307485 | PR |
NPI | 1184743510 |
---|---|
Provider Name | Mrs. Esmeralda Vasquez Martinez |
First Address | Cayey, PR 00736 |
Second Address | Cayey, PR 00736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051859 | CRUZ AZUL (01) | PR |
890207 | MMM (01) | PR |