Healthcare Provider Details

I. General information

NPI: 1902875214
Provider Name (Legal Business Name): MARK EMIL TRAUTMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 AVE DOMENECH
SAN JUAN PR
00918-3721
US

IV. Provider business mailing address

281 CALLE REY GUSTAVO LA VILLA DE TORRIMAR
GUAYNABO PR
00969-3262
US

V. Phone/Fax

Practice location:
  • Phone: 787-274-0822
  • Fax: 787-296-2293
Mailing address:
  • Phone: 787-274-0822
  • Fax: 787-296-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number12160
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: