Doctor Name: | LIDZOE CORREA- MATEO |
NPI Number: | 1609040229 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 17095 |
Business Practice Address: | R-28 Town Houses Coamo, PR - 007692818 |
Business Phone Number: | 7878258612 |
Business Fax Number: | |
Mailing Address: | R-28 Town Houses, COAMO |
State: | PR |
Postal Code: | 007692818 |
Phone Number: | 7878258612 |
Fax Number: | |
NPI Enumeration Date: | 04/15/2008 |
NPI Last Update Date: | 04/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 17095 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |