Healthcare Provider Details

I. General information

NPI: 1245232073
Provider Name (Legal Business Name): MANUEL ROCHE-ASENSIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 TH INFANTERIA 27B
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 1390
ANASCO PR
00610-1390
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-2526
  • Fax: 787-826-1018
Mailing address:
  • Phone: 787-826-2526
  • Fax: 787-826-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5844
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: