Healthcare Provider Details

I. General information

NPI: 1619972635
Provider Name (Legal Business Name): HUMBERTO SIMONETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date: 03/17/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

HOSPITAL SAN LUCAS II LOBBY AVE TITO CASTRO CARR 14 BO MACHUELO
PONCE PR
00731
US

IV. Provider business mailing address

P O BOX 7437
PONCE PUERTO RICO
00732-7437
UM

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax: 787-841-4832
Mailing address:
  • Phone: 17872597727
  • Fax: 17878414832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number7884
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7884
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: