Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | AC6770425 | PR |
NPI | 1063461465 |
---|---|
Provider Name | Mrs. Tomasita Cancel - Henriquez |
First Address | San Juan, PR 00922-0172 |
Second Address | San Juan, PR 00919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 14/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C79424 | (02) | PR |