Provider Demographics
NPI:1346278322
Name:DE VARONA, ROBERTO R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:R
Last Name:DE VARONA
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 1480
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1480
Mailing Address - Country:US
Mailing Address - Phone:787-637-8930
Mailing Address - Fax:
Practice Address - Street 1:M3 CALLE SANTA MARIA
Practice Address - Street 2:RESIDENCIAL BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1570
Practice Address - Country:US
Practice Address - Phone:787-745-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD34275Medicare UPIN
PR080334Medicare ID - Type UnspecifiedPROVIDER NUMBER