Healthcare Provider Details

I. General information

NPI: 1730277328
Provider Name (Legal Business Name): EDUARDO ACOSTA PUMAREJO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILAVILLE PINA 180
SAN JUAN PR
00926-5121
US

IV. Provider business mailing address

MILAVILLE PINA 180
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-4256
  • Fax: 787-641-4367
Mailing address:
  • Phone: 787-645-3028
  • Fax: 787-641-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number14318
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number14318
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number14318
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14318
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number14318
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: