Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 12181 | PR |
Y | 208D00000X | General Practice Physician | 21281 | PR |
NPI | 1023512837 |
---|---|
Provider Name | Vanessa Vando Rivera |
First Address | San Juan, PR 00921-3201 |
Second Address | San Juan, PR 00921-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 26/10/2020 |