=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750462966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN L DUQUELA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 728 AVE PONCE DE LEON SUITE 103
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-751-4295
-----------------------------------------------------
Fax | 787-756-8113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | EL SENORIAL MAIL STATION 552 WINSTON CHURCHILL AVE. #138
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-720-4207
-----------------------------------------------------
Fax | 787-731-1829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 3870
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------