Doctor Name: | ISMAEL MEDINA-AGOSTINI |
NPI Number: | 1760416291 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 12886 |
Business Practice Address: | 43 Ave Severiano Cuevas Aguadilla, PR - 006035766 |
Business Phone Number: | 7878914865 |
Business Fax Number: | 7878914865 |
Mailing Address: | 301 J.h. Cintron St, Estancias Del Golf Club PONCE |
State: | PR |
Postal Code: | 00730 |
Phone Number: | 7872845682 |
Fax Number: | 7872845682 |
NPI Enumeration Date: | 07/10/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 12886 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |