Healthcare Provider Details

I. General information

NPI: 1679632756
Provider Name (Legal Business Name): PABLO MOJICA MANOSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 AVE PONCE DE LEON # 715 PARADA 37
SAN JUAN PR
00918-1000
US

IV. Provider business mailing address

362 CAMINO DE LOS LAURELES SABANERA DEL RIO
GURABO PR
00778-5250
US

V. Phone/Fax

Practice location:
  • Phone: 787-771-7933
  • Fax:
Mailing address:
  • Phone: 787-744-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA90780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: