Healthcare Provider Details

I. General information

NPI: 1619902582
Provider Name (Legal Business Name): PEDRO J RULLAN MARIN MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON TORRE AUXILIO MUTUO # 512
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 AVE PONCE DE LEON TORRE AUXILIO MUTUO # 512
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-1910
  • Fax: 787-282-7131
Mailing address:
  • Phone: 787-751-1910
  • Fax: 787-282-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number8708
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number8708
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number8708
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: