Healthcare Provider Details

I. General information

NPI: 1992772099
Provider Name (Legal Business Name): MAGDIEL MAYOL-URDAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CEPYQ-HOSPITAL SAN FRANCISCO 371 DE DIEGO AVE.
SAN JUAN PR
00923
US

IV. Provider business mailing address

VISTA LOS FRAILES 150 CARR.873, APT.74
GUAYNABO PR
00969-5157
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5100
  • Fax: 787-620-4636
Mailing address:
  • Phone: 787-356-7175
  • Fax: 787-620-4636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number14248
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number14248
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: