Individual
TAI LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
80 CIUDAD JARDIN, CAROLINA, PR 00987
(703) 786-3860
Mailing address
80 CIUDAD JARDIN, CAROLINA, PR 00987
(703) 786-3860
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
18697
PR
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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