| NPI | 1780189902 |
|---|---|
| Former Name | IZADORA PORTO IZIDORO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME165428) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD-21547) |
| 208D00000X General Practice (Licence: NC 2020-00312) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2023-11-17 |