MEDICARE: MR. MANUEL ROCHE-ASENSIO 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	5844	PR

General Provider Information

NPI Number	:	1245232073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MANUEL ROCHE-ASENSIO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1390
Second Line	:
City	:	ANASCO
State	:	PR
Zip	:	00610-1390
Country	:	US
Telephone Number	:	787-826-2526
Fax Number	:	787-826-1018

Provider Business Practice Location Address
First Line	:	65 TH INFANTERIA
Second Line	:	27B
City	:	ANASCO
State	:	PR
Zip	:	00610
Country	:	US
Telephone Number	:	787-826-2526
Fax Number	:	787-826-1018

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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