Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1222 | PR |
NPI | 1093161556 |
---|---|
Provider Name | Wilfredo Gaudino Bonilla |
First Address | Cayey, PR 00736 |
Second Address | Cayey, PR 00736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2016 |
Last Update Date | 13/05/2016 |