Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 15888 | PR |
N | 207R00000X | Internist | 15888 | PR |
N | 111NI0900X | Internist | 15888 | PR |
N | 207R00000X | Internist | ME93943 | FL |
N | 111NI0900X | Internist | ME93943 | FL |
N | 208000000X | Pediatrician | 15888 | PR |
N | 208000000X | Pediatrician | ME93943 | FL |
NPI | 1215901426 |
---|---|
Provider Name | Dr. Anardi Agosto-Mujica |
First Address | Canovanas, PR 00729-3221 |
Second Address | Cayey, PR 00736-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 10/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273367600 | (05) | FL |
28690 | BLUE CROSS BLUE SHIELD (01) |