Healthcare Provider Details

I. General information

NPI: 1679531206
Provider Name (Legal Business Name): NORMA E AGOSTO-MAURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A2 CALLE LODI URB VILLA LUARCA
SAN JUAN PR
00924
US

IV. Provider business mailing address

A2 CALLE LODI URB VILLA LUARCA
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-5955
  • Fax: 787-767-0516
Mailing address:
  • Phone: 787-751-5955
  • Fax: 787-767-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number4731
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: