Healthcare Provider Details

I. General information

NPI: 1174589139
Provider Name (Legal Business Name): ADANETTE WISCOVITCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PONCE DE LEON AVE AUXILIO MUTUO PDA 37 1/2
HATO REY PR
00923
US

IV. Provider business mailing address

MONTEHEIDRA TOWN CTR 53 FALCON ST.
SAN JUAN PR
00926-7007
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax: 787-771-7996
Mailing address:
  • Phone: 787-731-1346
  • Fax: 787-771-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number9670
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: