Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1398 | PR |
NPI | 1003082843 |
---|---|
Provider Name | Mrs. Marta I Colon |
First Address | San Juan, PR 00926 |
Second Address | Humacao, PR 00791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 01/05/2008 |