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General NPI Number Information
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NPI Number | 1003655275
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Entity Type | Individual
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Provider Name | MARIO B GOITIA DURAN MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 735 AVE PONCE DE LEON
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City | SAN JUAN
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 939-390-4382
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Fax |
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Provider Business Mailing Address
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Address Line | URB MONTEHIEDRA CALLE GUARAGUAO 142
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-238-8834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 24562
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License Number State | PR
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