MEDICARE: DR. JAIME RAFAEL GIERBOLINI DMD

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	1223G0001X	General Practice Dentistry	958	PR

General Provider Information

NPI Number	:	1174660575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME RAFAEL GIERBOLINI DMD

Provider Business Mailing Address
First Line	:	49 CALLE JOSE I QUINTON
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2448
Country	:	US
Telephone Number	:	787-825-1660
Fax Number	:	787-825-1660

Provider Business Practice Location Address
First Line	:	49 CALLE JOSE I QUINTON
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2448
Country	:	US
Telephone Number	:	787-825-1660
Fax Number	:	787-825-1660

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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