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General NPI Number Information
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NPI Number | 1760592687
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Entity Type | Individual
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Provider Name | MARIELY AGOSTO M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HE10 AVENUE AMALIA PAOLI
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-261-3465
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Fax | 787-261-3415
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Provider Business Mailing Address
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Address Line | HM23 CALLE RAMON MORLA
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City | TOA BAJA
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State | PR
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Zip | 00949-3747
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Country | US
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Telephone | 787-261-3465
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Fax | 787-261-3415
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12203
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License Number State | PR
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