Provider Demographics
NPI:1235339623
Name:MANON SCHOTBORGH, ROGELIO ALBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGELIO
Middle Name:ALBERTO
Last Name:MANON SCHOTBORGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1046
Mailing Address - Country:US
Mailing Address - Phone:787-473-1261
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA SANTA TERESA TOURNET #617
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-473-1261
Practice Address - Fax:787-851-3932
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
24958Medicare PIN
18914Medicare UPIN