| NPI | 1649563859 |
|---|---|
| Former Name | TANYA BACA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: RI MD15796) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD15796) |
| 208000000X Pediatrics (Licence: RI LP02163) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2018-10-03 |