1669465373 NPI number — DR. AGUSTIN MEDINA-ROSARIO M.D.

Table of content: DR. AGUSTIN MEDINA-ROSARIO M.D. (NPI 1669465373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669465373 NPI number — DR. AGUSTIN MEDINA-ROSARIO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDINA-ROSARIO
Provider First Name:
AGUSTIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669465373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1705
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-744-3136
Provider Business Mailing Address Fax Number:
787-744-0567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CALLE MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
EDIFICIO PROFESIONAL OFICINA 302
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-3136
Provider Business Practice Location Address Fax Number:
787-744-0567
Provider Enumeration Date:
08/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  2872 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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