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General NPI Number Information
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NPI Number | 1265539837
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Entity Type | Individual
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Provider Name | MARITZA CORREA AGOSTO DMD
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Gender | Female
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 667 CALLE LA PAZ STE 101
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-723-9947
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Fax | 787-723-9947
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Provider Business Mailing Address
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Address Line | PO BOX 368015
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City | SAN JUAN
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State | PR
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Zip | 00936-8815
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Country | US
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Telephone | 787-378-3599
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1509
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License Number State | PR
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