Provider Demographics
NPI:1467429316
Name:BOSCIO, ISABEL C (DMD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:C
Last Name:BOSCIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 AVE LUIS VIGOREAUX
Mailing Address - Street 2:APT 11 D
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2506
Mailing Address - Country:US
Mailing Address - Phone:787-781-7118
Mailing Address - Fax:
Practice Address - Street 1:1311 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2118
Practice Address - Country:US
Practice Address - Phone:787-793-2810
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR42522OtherTRIPLE S