Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F308833-1 | NY |
NPI | 1053964650 |
---|---|
Provider Name | Paz Menjivar |
First Address | New Hyde Park, NY 11040-1972 |
Second Address | New Hyde Park, NY 11040-1972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 23/07/2019 |