Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01081104A | IN |
NPI | 1134519911 |
---|---|
Provider Name | Rikizam Magada Joya |
First Address | Lafayette, IN 47904-3240 |
Second Address | Lafayette, IN 47904-3240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2015 |
Last Update Date | 22/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300018286 | (05) | IN |