MEDICARE: SERGIO MIGUEL AYMAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	17497	PR

General Provider Information

NPI Number	:	1023868254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO MIGUEL AYMAT

Provider Business Mailing Address
First Line	:	PO BOX 10490
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-0490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 AVE LAUREL
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00956-3273
Country	:	US
Telephone Number	:	787-903-0508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	04/13/2026

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