Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 00462 |
NPI | 1093206435 |
---|---|
Provider Name | Ms. Virgen Gonzalez |
First Address | San Juan, PR 00924 |
Second Address | San Juan, PR 00924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2018 |
Last Update Date | 22/09/2021 |