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ProviderCode | Provider Name | Physician ID | Last Name | First Name | Middle Name | TIN # | Specialization | Sub Specialization |
|---|---|---|---|---|---|---|---|---|
'002686 | LIFESPAN MEDICAL CLINIC AND DIAGNOSTIC CENTER, INC. | '013651 | DE GUZMAN | ANA KATRINA | ANTONIO | 458924406 | Pediatric | |
'002686 | LIFESPAN MEDICAL CLINIC AND DIAGNOSTIC CENTER, INC. | '001412 | SO | EDISON | 215300155 | Internal Medicine | ||
'002686 | LIFESPAN MEDICAL CLINIC AND DIAGNOSTIC CENTER, INC. | '027886 | CUERPO | PETER JOHN | Pediatric |
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