Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 768 | PR |
NPI | 1205496692 |
---|---|
Provider Name | Zory Mary Feliciano Gonzalez |
First Address | Ponce, PR 00732-8730 |
Second Address | Ponce, PR 00728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 18/06/2019 |