Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 10489 | PR |
NPI | 1023215621 |
---|---|
Provider Name | Mrs. Lydia Esther Colon |
First Address | Penuelas, PR 00624 |
Second Address | Penuelas, PR 00624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F47613 | (02) |