Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 673 | PR |
NPI | 1013124148 |
---|---|
Provider Name | Mrs. Rose Coraly Nieves Campis |
First Address | Cabo Rojo, PR 00623 |
Second Address | Cabo Rojo, PR 00623-4359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |