Healthcare Provider Details

I. General information

NPI: 1053387506
Provider Name (Legal Business Name): CARLOS A. BUJOSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CALLE CARAZO
GUAYNABO PR
00969-5717
US

IV. Provider business mailing address

112 CALLE CARAZO
GUAYNABO PR
00969-5717
US

V. Phone/Fax

Practice location:
  • Phone: 787-708-2984
  • Fax:
Mailing address:
  • Phone: 787-708-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number12114
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: