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NPI Code Detail

MEDICARE: MR. MAXIMO C BLONDET PASSALACQUA MD,FCCP

MEDICARE: MR. MAXIMO C BLONDET PASSALACQUA MD,FCCP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist13199PR

General Provider Information

NPI Number : 1184614927
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MAXIMO C BLONDET PASSALACQUA MD,FCCP
Provider Business Mailing Address
First Line : 400 AVE FD ROOSEVELT
Second Line : EDIF CLINICA LAS AMERICAS OFIC 205
City : SAN JUAN
State : PR
Zip : 00918-2103
Country : US
Telephone Number : 787-765-1919
Fax Number : 787-763-4049
Provider Business Practice Location Address
First Line : 400 AVE FD ROOSEVELT
Second Line : EDIF CLINICA LAS AMERICAS OFIC 205
City : SAN JUAN
State : PR
Zip : 00918-2103
Country : US
Telephone Number : 787-765-1919
Fax Number : 787-763-4049
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 06/07/2017

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