Provider Demographics
NPI:1124024542
Name:MANTERO HORMAZABAL, JULIO CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:CESAR
Last Name:MANTERO HORMAZABAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:154 CALLE COLA DE PESCADO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5818
Mailing Address - Country:US
Mailing Address - Phone:787-798-1645
Mailing Address - Fax:787-798-1604
Practice Address - Street 1:1845 CARR 2
Practice Address - Street 2:STE 606
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7204
Practice Address - Country:US
Practice Address - Phone:787-798-1645
Practice Address - Fax:787-798-1604
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8555OtherSTATE LICENSE
PR80017Medicare ID - Type Unspecified
PR8555OtherSTATE LICENSE