MEDICARE: DR. FEDERICO A MAESTRE GRAU MD

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	207W00000X	Ophthalmology Physician	9085	PR

General Provider Information

NPI Number	:	1679561047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FEDERICO A MAESTRE GRAU MD

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

Provider Business Practice Location Address
First Line	:	357 AVE DE LA CONSTITUCION
Second Line	:	PUERTA DE TIERRA
City	:	SAN JUAN
State	:	PR
Zip	:	00901-2208
Country	:	US
Telephone Number	:	787-289-6600
Fax Number	:	787-289-6622

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/08/2011

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