Doctor Name: | GRACE D MEDESTOMAS |
NPI Number: | 1609814227 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 15229 |
Business Practice Address: | #21 Calle Juan Garzon Naguabo, PR - 00718 |
Business Phone Number: | 7874650664 |
Business Fax Number: | |
Mailing Address: | Po Box 918, NAGUABO |
State: | PR |
Postal Code: | 00718 |
Phone Number: | 7878742495 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2006 |
NPI Last Update Date: | 08/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 15229 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |