Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2016-01671 | NC |
Y | 208600000X | Surgeon | 2016-01671 | NC |
NPI | 1013312826 |
---|---|
Provider Name | Roberto Jose Arias Gautreaux |
First Address | Valhalla, NY 10595-1530 |
Second Address | Valhalla, NY 10595-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 02/07/2021 |