Healthcare Provider Details

I. General information

NPI: 1154307015
Provider Name (Legal Business Name): JUAN R PILLOT COSTAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CALLE LUIS MUNOZ RIVERA SUITE #2
GUAYANILLA PR
00656
US

IV. Provider business mailing address

PO BOX 8042
PONCE PR
00732-8042
US

V. Phone/Fax

Practice location:
  • Phone: 787-835-5956
  • Fax: 787-835-5959
Mailing address:
  • Phone: 787-835-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10019
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10019
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: