Healthcare Provider Details

I. General information

NPI: 1568437002
Provider Name (Legal Business Name): JOSE MARINO LOINAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO MEDICO HERMANAS DAVILA CALLE J ESQ. B 206
BAYAMON PUERTO RICO
00959
UM

IV. Provider business mailing address

PO BOX 2025 BAYAMON
BAYAMON PUERTO RICO
00960
UM

V. Phone/Fax

Practice location:
  • Phone: 787-740-5151
  • Fax: 787-740-3001
Mailing address:
  • Phone: 787-740-5151
  • Fax: 787-740-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4180
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: