Healthcare Provider Details

I. General information

NPI: 1992722854
Provider Name (Legal Business Name): CESAR H TRABANCO DE LA CRUZ MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BY PASS 1006 PARRA MEDICAL INSTITUTE
PONCE PR
00717-1382
US

IV. Provider business mailing address

PO BOX 10578
PONCE PR
00732-0578
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-7168
  • Fax: 787-840-1552
Mailing address:
  • Phone: 787-841-7168
  • Fax: 787-840-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number7904
License Number StatePR

VIII. Authorized Official

Name: CESAR H TRABANCO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-841-7168