MEDICARE: DR. JOSE JESUS LARRAURI RENTA M.D.

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	7382	PR

General Provider Information

NPI Number	:	1043223506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE JESUS LARRAURI RENTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1883
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-1883
Country	:	US
Telephone Number	:	787-825-1224
Fax Number	:	787-825-0763

Provider Business Practice Location Address
First Line	:	1 CALLE MARIO BRASCHI
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2501
Country	:	US
Telephone Number	:	787-825-1224
Fax Number	:	787-825-0763

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/01/2012

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