=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033216742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARTURO ALEJANDRO NOLASCO GARRIDO MEDICAL DOCTOR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2006
-----------------------------------------------------
Last Update Date | 08/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 BDA MONACILLOS PASEO DR. JOSE CELSO BARBOSA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-777-3535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BH16 CALLE 110 APT A VALLE ARRIBA HEIGHTS
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00983-3345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-315-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 15732
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------