Provider Demographics
NPI:1518008770
Name:DE POOL, MAGDA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGDA ELAINE
Middle Name:
Last Name:DE POOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAGDA ELAINE
Other - Middle Name:
Other - Last Name:DE POOL FIGUEROA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1465
Mailing Address - Country:US
Mailing Address - Phone:787-785-6410
Mailing Address - Fax:787-785-6468
Practice Address - Street 1:B1 CALLE SANTA CRUZ
Practice Address - Street 2:STE 502
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6946
Practice Address - Country:US
Practice Address - Phone:787-785-6410
Practice Address - Fax:787-785-6468
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13459207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH12694Medicare UPIN
PR0020631Medicare ID - Type Unspecified