Healthcare Provider Details

I. General information

NPI: 1063487171
Provider Name (Legal Business Name): ISMAEL TORO GRAJALES MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B7 CALLE SANTA CRUZ URB. SANTA CRUZ
BAYAMON PR
00961-6902
US

IV. Provider business mailing address

B7 CALLE SANTA CRUZ URB. SANTA CRUZ
BAYAMON PR
00961-6902
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-9316
  • Fax: 787-778-4793
Mailing address:
  • Phone: 787-780-9316
  • Fax: 787-778-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number7177
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: