Provider Demographics
NPI:1063487171
Name:TORO GRAJALES, ISMAEL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:TORO GRAJALES
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B7 CALLE SANTA CRUZ
Mailing Address - Street 2:URB. SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6902
Mailing Address - Country:US
Mailing Address - Phone:787-780-9316
Mailing Address - Fax:787-778-4793
Practice Address - Street 1:B7 CALLE SANTA CRUZ
Practice Address - Street 2:URB. SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6902
Practice Address - Country:US
Practice Address - Phone:787-780-9316
Practice Address - Fax:787-778-4793
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7177207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098786Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRC78250Medicare UPIN