MEDICARE: DR. AGUSTIN MEDINA-ROSARIO 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	208800000X	Urology Physician	2872	PR

General Provider Information

NPI Number	:	1669465373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGUSTIN MEDINA-ROSARIO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1705
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-1705
Country	:	US
Telephone Number	:	787-744-3136
Fax Number	:	787-744-0567

Provider Business Practice Location Address
First Line	:	2 CALLE MUNOZ RIVERA
Second Line	:	EDIFICIO PROFESIONAL OFICINA 302
City	:	CAGUAS
State	:	PR
Zip	:	00725-2603
Country	:	US
Telephone Number	:	787-744-3136
Fax Number	:	787-744-0567

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

Provider Enumeration Date	:	08/27/2005
Last Update Date	:	07/08/2007

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