Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 9666 | PR |
NPI | 1013127224 |
---|---|
Provider Name | Ricardo Enrique Pena |
First Address | Caguas, PR 00725-1937 |
Second Address | Caguas, PR 00725-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |