MEDICARE: YESMIN FADUL PAULINO MD

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	15138	PR

General Provider Information

NPI Number	:	1104810373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESMIN FADUL PAULINO MD

Provider Business Mailing Address
First Line	:	471 VIA MARBELLA
Second Line	:	URB PASEO DEL MAR
City	:	DORADO
State	:	PR
Zip	:	00646-4646
Country	:	US
Telephone Number	:	787-261-7659
Fax Number	:	787-778-1567

Provider Business Practice Location Address
First Line	:	73 CALLE SANTA CRUZ
Second Line	:	SANTA CRUZ MEDICAL BLDG STE 409
City	:	BAYAMON
State	:	PR
Zip	:	00961-6910
Country	:	US
Telephone Number	:	787-778-1567
Fax Number	:	787-778-1567

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/08/2007

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