Provider Demographics
NPI:1306041702
Name:BOSSANA, ERICA LILIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LILIANA
Last Name:BOSSANA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 190090
Mailing Address - Street 2:HATO REY STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0990
Mailing Address - Country:US
Mailing Address - Phone:787-603-2411
Mailing Address - Fax:787-276-0065
Practice Address - Street 1:CARR #3 KM 12.3
Practice Address - Street 2:65 INFANTERIA AVE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00919-0990
Practice Address - Country:US
Practice Address - Phone:787-603-2411
Practice Address - Fax:787-276-0065
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16605208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16605OtherLICENCIA MD