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General NPI Number Information
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NPI Number | 1427057801
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Entity Type | Individual
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Provider Name | MYRNA M AGOSTO OD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 12/26/2016
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Provider Practice Location Address
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Address Line | CALLE GEORGETTI #128
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City | NARANJITO
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State | PR
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Zip | 00719-3025
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Country | US
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Telephone | 787-869-1911
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Fax | 787-730-4966
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Provider Business Mailing Address
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Address Line | A5 A STREET TOA LINDA
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City | TOA ALTA
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State | PR
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Zip | 00953
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Country | US
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Telephone | 787-730-4966
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Fax | 787-730-4966
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 312
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License Number State | PR
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