Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 4225 | PR |
NPI | 1033180179 |
---|---|
Provider Name | Mrs. Maria Ivette Gonzalez |
First Address | Aguadilla, PR 00604-0144 |
Second Address | Aguadilla, PR 00603-5877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D95839 | (02) | PR |