Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15674-I | PR |
NPI | 1003401191 |
---|---|
Provider Name | Rey Antonio Aponte-Rivera |
First Address | Bayamon, PR 00959 |
Second Address | Bayamon, PR 00959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2021 |
Last Update Date | 07/04/2021 |