Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 22647 | TX |
NPI | 1124210059 |
---|---|
Provider Name | Ms. Juliana Robledo |
First Address | San Antonio, TX 78209-4844 |
Second Address | San Antonio, TX 78209-4844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U99484 | (02) | NE |