MEDICARE: DAMARYS BOSCHETTI 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	208000000X	Pediatrics Physician	10255	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88595	OTHER	PR	TRIPLE-S PROVIDER NUMBER

General Provider Information

NPI Number	:	1669555132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMARYS BOSCHETTI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 363929
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-3929
Country	:	US
Telephone Number	:	787-766-1087
Fax Number	:	787-274-1989

Provider Business Practice Location Address
First Line	:	REPARTO METROPOLITANO
Second Line	:	CALLE 42 SE #1012
City	:	SAN JUAN
State	:	PR
Zip	:	00921
Country	:	US
Telephone Number	:	787-766-1087
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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Directions to “ DAMARYS BOSCHETTI M.D.” Practice Location

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