Healthcare Provider Details

I. General information

NPI: 1427033612
Provider Name (Legal Business Name): EDGARDO ALBERTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AMERICO SALAS 1452
SANTURCE PR
00909
US

IV. Provider business mailing address

PO BOX 19446 FERNANDEZ JUNCOS STATION
SAN JUAN PR
00910
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-6297
  • Fax: 787-724-6490
Mailing address:
  • Phone: 787-725-6297
  • Fax: 787-724-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4354
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: