Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 7213 | PR |
N | 111NI0900X | Internist | 7213 | PR |
Y | 207U00000X | Nuclear Medicine Specialist | 7213 | PR |
NPI | 1184680480 |
---|---|
Provider Name | Sandra C. Gracia-Lopez |
First Address | San Juan, PR 00926-6459 |
Second Address | Aibonito, PR 00705-1379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 02/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E04102 | (02) | PR |