Provider Demographics
NPI:1386641538
Name:PUJOL ANGOMAS, BIANCA S (MD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:S
Last Name:PUJOL ANGOMAS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:116 CALLE CORAL
Mailing Address - Street 2:PARQUE DE ISLA VERDE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1364
Mailing Address - Country:US
Mailing Address - Phone:787-374-4109
Mailing Address - Fax:787-253-1428
Practice Address - Street 1:312 AVE DE DIEGO
Practice Address - Street 2:TORRE MUSEO BLDG
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1756
Practice Address - Country:US
Practice Address - Phone:787-480-3702
Practice Address - Fax:787-724-4057
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2016-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR10897208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10897OtherLICENSE
PR89861Medicare ID - Type Unspecified
PR10897OtherLICENSE