Healthcare Provider Details

I. General information

NPI: 1568089282
Provider Name (Legal Business Name): EDWIN JOSE PLAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO SAN VICENTE DE PAUL OFICINA 308
SAN GERMAN PR
00683
US

IV. Provider business mailing address

131 CALLE ROSARIO
CABO ROJO PR
00623-3913
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-2269
  • Fax:
Mailing address:
  • Phone: 787-851-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number21807
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: