MEDICARE: DR. CONRADO W ASENJO 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	207RG0100X	Gastroenterology Physician	11874	PR

General Provider Information

NPI Number	:	1104835073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONRADO W ASENJO MD

Provider Business Mailing Address
First Line	:	89 AVE DE DIEGO
Second Line	:	SUITE 105 PMB-407
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6372
Country	:	US
Telephone Number	:	787-754-5091
Fax Number	:	787-753-1783

Provider Business Practice Location Address
First Line	:	369 DE DIEGO AVE.
Second Line	:	TORRE SAN FRANCISCO SUITE 602
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3005
Country	:	US
Telephone Number	:	787-754-5091
Fax Number	:	787-753-1783

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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