Healthcare Provider Details

I. General information

NPI: 1972587558
Provider Name (Legal Business Name): JOSE G IGUINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C MARGINAL SANTA CRUZ D-2 URB SANTA CRUZ
BAYAMON PR
00958
US

IV. Provider business mailing address

C A HAMBRA 4 #9 URB TORRIMAR
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-5542
  • Fax: 787-785-5543
Mailing address:
  • Phone: 787-783-0144
  • Fax: 787-785-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10574
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: