Provider Demographics
NPI:1295843118
Name:MAESTRE-GARCIA, IVONNE (MD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:MAESTRE-GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 CALLE PETUNIA
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2242
Mailing Address - Country:US
Mailing Address - Phone:787-776-2050
Mailing Address - Fax:787-776-2050
Practice Address - Street 1:AVE. MONSERRATE AA 3
Practice Address - Street 2:VALLE ARRIBA HEIGHTS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-776-2050
Practice Address - Fax:787-776-2050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11887208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88849Medicare ID - Type Unspecified