MEDICARE: DR. JULIO CESAR MANTERO HORMAZABAL 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	207R00000X	Internal Medicine Physician	8555	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8555	OTHER	PR	STATE LICENSE

General Provider Information

NPI Number	:	1124024542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIO CESAR MANTERO HORMAZABAL M.D.

Provider Business Mailing Address
First Line	:	154 CALLE COLA DE PESCADO
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5818
Country	:	US
Telephone Number	:	787-798-1645
Fax Number	:	787-798-1604

Provider Business Practice Location Address
First Line	:	1845 CARR 2
Second Line	:	STE 606
City	:	BAYAMON
State	:	PR
Zip	:	00959-7204
Country	:	US
Telephone Number	:	787-798-1645
Fax Number	:	787-798-1604

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/24/2017

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