Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 11795 | PR |
NPI | 1043342736 |
---|---|
Provider Name | Roberto Perez-Nieves |
First Address | Mercedita, PR 00715-0388 |
Second Address | Ponce, PR 00716-4717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |