Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 7558 | PR |
NPI | 1043271430 |
---|---|
Provider Name | Yolanda Varela Rosa |
First Address | Aguada, PR 00602 |
Second Address | Aguada, PR 00602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 11/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D08541 | (02) |