Provider Demographics
NPI:1639537806
Name:ALLENDE MOURE, JOSE ROBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ROBERTO
Last Name:ALLENDE MOURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0878
Mailing Address - Country:US
Mailing Address - Phone:787-636-6656
Mailing Address - Fax:787-809-1144
Practice Address - Street 1:A3 CALLE GARCIA DE LA NOCEDA
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-636-6656
Practice Address - Fax:787-809-1144
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR19778208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice