MEDICARE: MR. MARIO A HADDAD 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	174400000X	Specialist	9042	PR

General Provider Information

NPI Number	:	1750386652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO A HADDAD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1969
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00970-1969
Country	:	US
Telephone Number	:	787-767-7885
Fax Number	:	787-767-5626

Provider Business Practice Location Address
First Line	:	TORRE AUXILIO MUTUO SUITE 413
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919
Country	:	US
Telephone Number	:	787-767-7885
Fax Number	:	787-767-5626

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/14/2014

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