MEDICARE: DR. ROBERTO A MENJIVAR 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	13676	PR

General Provider Information

NPI Number	:	1730149808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO A MENJIVAR M.D

Provider Business Mailing Address
First Line	:	SABANERA STREET FINQUITAS DEL MONTE
Second Line	:	#312
City	:	CIDRA
State	:	PR
Zip	:	00739
Country	:	US
Telephone Number	:	787-421-0454
Fax Number	:

Provider Business Practice Location Address
First Line	:	DOCTORS' CENTER HOSPITAL
Second Line	:	1395 CALLE SAN RAFAEL
City	:	SANTURCE
State	:	PR
Zip	:	00910
Country	:	US
Telephone Number	:	787-999-7620
Fax Number	:	787-725-2124

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	06/12/2018

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