Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D0075541 | MD |
Y | 111NI0900X | Internist | D0075541 | MD |
NPI | 1003122235 |
---|---|
Provider Name | Percy Ivan Valenzuela Canepa |
First Address | Baltimore, MD 21237-3901 |
Second Address | Baltimore, MD 21237-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 14/08/2015 |