Provider Demographics
NPI:1619972635
Name:SIMONETTI, HUMBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:SIMONETTI
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:P O BOX 7437
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00732-7437
Mailing Address - Country:UM
Mailing Address - Phone:1787-259-7727
Mailing Address - Fax:1787-841-4832
Practice Address - Street 1:HOSPITAL SAN LUCAS II LOBBY
Practice Address - Street 2:AVE TITO CASTRO CARR 14 BO MACHUELO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-844-2080
Practice Address - Fax:787-841-4832
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-12-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
PR7884174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE70854Medicare UPIN
PR0082285Medicare ID - Type Unspecified