Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 17977 | PR |
Y | 2080P0210X | Pediatric Nephrologist | 17977 | PR |
NPI | 1356540801 |
---|---|
Provider Name | Nilka Dejesus - Gonzalez |
First Address | San Juan, PR 00929-0134 |
Second Address | Rio Piedras, PR 00921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2007 |
Last Update Date | 12/08/2013 |