Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15244 | PR |
NPI | 1043200710 |
---|---|
Provider Name | Sandra I Rivera Llamas |
First Address | Guaynabo, PR 00969 |
Second Address | San Juan, PR 00926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 11/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102909 | (02) | PR |
I-02909 | (02) | PR |