Provider Demographics
NPI:1275179731
Name:MACEDONIO, MICHAEL JOVANY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOVANY
Last Name:MACEDONIO
Suffix:
Gender:M
Credentials:
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 7793
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7793
Mailing Address - Country:US
Mailing Address - Phone:787-284-5884
Mailing Address - Fax:787-651-3333
Practice Address - Street 1:CALLE PROF AUGUSTO
Practice Address - Street 2:SUITE 600 COND ASIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-497-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744G0900XOther Service ProvidersSpecialistGraphics Designer