Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 4744 | PR |
NPI | 1134252174 |
---|---|
Provider Name | Nelida Martinez Vazquez |
First Address | Juncos, PR 00777-0996 |
Second Address | Juncos, PR 00777-0996 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D33459 | (02) | PR |