Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME29180 | FL |
NPI | 1033142377 |
---|---|
Provider Name | Vitaly Jaime Alalu |
First Address | Boynton Beach, FL 33474-0177 |
Second Address | Lake Worth, FL 33467-2948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 19/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065172900 | (05) | FL |
D70610 | (02) |