Provider Demographics
NPI:1417411141
Name:GOYCO VERA, DANIEL E
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:GOYCO VERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 AVE ARTERIAL HOSTOS APT C16
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-5024
Mailing Address - Country:US
Mailing Address - Phone:787-617-8683
Mailing Address - Fax:
Practice Address - Street 1:170 AVE ARTERIAL HOSTOS APT C16
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-5024
Practice Address - Country:US
Practice Address - Phone:787-617-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program