MEDICARE: DR. WILFRED FAISCA M.D.

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
1	174400000X	Specialist	5131	PR

General Provider Information

NPI Number	:	1336124841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILFRED FAISCA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1799
Second Line	:
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00977-1799
Country	:	US
Telephone Number	:	787-755-6354
Fax Number	:	787-755-3285

Provider Business Practice Location Address
First Line	:	CARRETERA 845 KM. 3.2
Second Line	:	D-32 FAIR VIEW
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-755-6354
Fax Number	:	787-755-3285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	05/03/2012

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