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NPI Code Detail

MEDICARE: DR. SERGIO RAFAEL MOURE-RODRIGUEZ M.D.

MEDICARE: DR. SERGIO RAFAEL MOURE-RODRIGUEZ 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
1174400000XSpecialist8128PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1066345OTHERPRLA CRUZ AZUL DE PR
2204040OTHERPRPREFERRED HEALTH CARE
329466OTHERPRTRIPLE S
433-08128OTHERPRUIA
5960010OTHERPRHUMANA HEALTH CARE
60116OTHERPRFIRST MEDICAL CARD SYSTEM

General Provider Information

NPI Number : 1508869165
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SERGIO RAFAEL MOURE-RODRIGUEZ M.D.
Provider Business Mailing Address
First Line : PO BOX 3866
Second Line :
City : GUAYNABO
State : PR
Zip : 00970-3866
Country : US
Telephone Number : 787-787-7191
Fax Number : 787-786-3667
Provider Business Practice Location Address
First Line : EDIF INSTITUTO SAN PABLO
Second Line : SUITE 303
City : BAYAMON
State : PR
Zip : 00961-7041
Country : US
Telephone Number : 787-787-7191
Fax Number : 787-786-3667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 01/13/2010

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