Healthcare Provider Details

I. General information

NPI: 1194040410
Provider Name (Legal Business Name): MARIOLA MONAGAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 CALLE TOMAS AGRAIT CLUB MANOR
SAN JUAN PR
00924-4333
US

IV. Provider business mailing address

125 CALLE JOSE DE DIEGO CLUB MANOR
AGUADILLA PR
00603-5175
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-4100
  • Fax:
Mailing address:
  • Phone: 787-882-7766
  • Fax: 787-882-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18530
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: