Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 6186 | PR |
NPI | 1548278260 |
---|---|
Provider Name | Mrs. Gloria M Montes Burgos |
First Address | Orocovis, PR 00720-1475 |
Second Address | Orocovis, PR 00720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 02/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D08420 | (02) | PR |