Healthcare Provider Details

I. General information

NPI: 1699773002
Provider Name (Legal Business Name): DAVID STORER-BLASINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVE SUITE 616
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 PONCE DE LEON AVE SUITE 616
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-7474
  • Fax: 787-759-3776
Mailing address:
  • Phone: 787-751-7474
  • Fax: 787-759-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3878
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: