Healthcare Provider Details

I. General information

NPI: 1336244524
Provider Name (Legal Business Name): SALOMON A MONSERRATE COSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539A CALLE S CUEVAS BUSTAMANTE
SAN JUAN PR
00918-2681
US

IV. Provider business mailing address

539A CALLE S CUEVAS BUSTAMANTE
SAN JUAN PR
00918-2681
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-0054
  • Fax: 787-848-0318
Mailing address:
  • Phone: 787-765-0054
  • Fax: 787-848-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2470
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: