Healthcare Provider Details

I. General information

NPI: 1568251114
Provider Name (Legal Business Name): TOSCANIA Y. FULGENCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 876 ESQUINA CLL ANICETO DIAZ A3 URB GOLDEN HILLS
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

PO BOX 1143
AGUADA PR
00602-1143
US

V. Phone/Fax

Practice location:
  • Phone: 787-589-0003
  • Fax:
Mailing address:
  • Phone: 787-589-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24734
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: