Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 14925-I | PR |
Y | 111NI0900X | Internist | 14925-I | PR |
NPI | 1003395062 |
---|---|
Provider Name | Vivian Milagros Garza |
First Address | Aguadilla, PR 00605 |
Second Address | Aguadilla, PR 00603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2018 |
Last Update Date | 10/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14925-I | JUNTA LICENCIA MEDICA PUERTO RICO (01) | PR |