Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 231964 | MA |
NPI | 1063440733 |
---|---|
Provider Name | Mrs. Ingrid Beatriz Avalos |
First Address | Boston, MA 02215-5501 |
Second Address | Boston, MA 02215-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 05/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32-0058309 | (05) | MA |