MEDICARE: DR. EDGAR RAMON BASTARDO AGUILAR

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1710732730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGAR RAMON BASTARDO AGUILAR

Provider Business Mailing Address
First Line	:	PO BOX 104
Second Line	:
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771-0104
Country	:	US
Telephone Number	:	787-427-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 104
Second Line	:
City	:	LAS PIEDRAS
State	:	PR
Zip	:	00771-0104
Country	:	US
Telephone Number	:	787-427-9539
Fax Number	:

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

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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