Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1261 | PR |
NPI | 1154891950 |
---|---|
Provider Name | Mrs. Marie Angelie Martinez |
First Address | Ponce, PR 00728 |
Second Address | Juana Diaz, PR 00795-1633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2018 |
Last Update Date | 05/12/2018 |