1679561047 NPI number — DR. FEDERICO A MAESTRE GRAU MD

Table of content: DR. KEVIN DOYLE CARTER M.D. (NPI 1194763912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679561047 NPI number — DR. FEDERICO A MAESTRE GRAU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAESTRE GRAU
Provider First Name:
FEDERICO
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAESTRE GRAU
Provider Other First Name:
FEDERICO
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679561047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13953
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00908-3953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-289-6600
Provider Business Mailing Address Fax Number:
787-289-6622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
357 AVE DE LA CONSTITUCION
Provider Second Line Business Practice Location Address:
PUERTA DE TIERRA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00901-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-289-6600
Provider Business Practice Location Address Fax Number:
787-289-6622
Provider Enumeration Date:
10/11/2005

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: 207W00000X , with the licence number:  9085 , 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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