Provider Demographics
NPI:1619902582
Name:RULLAN MARIN, PEDRO J (MD, FACS)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:RULLAN MARIN
Suffix:
Gender:M
Credentials:MD, FACS
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Other - Credentials:
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:TORRE AUXILIO MUTUO # 512
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-751-1910
Mailing Address - Fax:787-282-7131
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE AUXILIO MUTUO # 512
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-751-1910
Practice Address - Fax:787-282-7131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR8708207Y00000X, 207YP0228X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81379Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER