Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | L3586 | TX |
NPI | 1184663163 |
---|---|
Provider Name | Renato Victor Bosita |
First Address | Plano, TX 75026-2409 |
Second Address | Plano, TX 75093-8171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1506107-03 | (05) | TX |
H55259 | (02) | TX |