| NPI | 1518354604 |
|---|---|
| Former Name | JENNIFER MICHELLE DECOSTE-LOPEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2018-02052) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-11-06 |