Healthcare Provider Details

I. General information

NPI: 1275179731
Provider Name (Legal Business Name): MICHAEL JOVANY MACEDONIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PROF AUGUSTO SUITE 600 COND ASIA
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 7793
PONCE PR
00732-7793
US

V. Phone/Fax

Practice location:
  • Phone: 787-497-0800
  • Fax:
Mailing address:
  • Phone: 787-284-5884
  • Fax: 787-651-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: