Provider Demographics
NPI:1669465373
Name:MEDINA-ROSARIO, AGUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:
Last Name:MEDINA-ROSARIO
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:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1705
Mailing Address - Country:US
Mailing Address - Phone:787-744-3136
Mailing Address - Fax:787-744-0567
Practice Address - Street 1:2 CALLE MUNOZ RIVERA
Practice Address - Street 2:EDIFICIO PROFESIONAL OFICINA 302
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2603
Practice Address - Country:US
Practice Address - Phone:787-744-3136
Practice Address - Fax:787-744-0567
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2872208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC83848Medicare UPIN
PR0094561Medicare ID - Type Unspecified