Provider Demographics
NPI:1679561047
Name:MAESTRE GRAU, FEDERICO A (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:A
Last Name:MAESTRE GRAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FEDERICO
Other - Middle Name:A
Other - Last Name:MAESTRE GRAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13953
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3953
Mailing Address - Country:US
Mailing Address - Phone:787-289-6600
Mailing Address - Fax:787-289-6622
Practice Address - Street 1:357 AVE DE LA CONSTITUCION
Practice Address - Street 2:PUERTA DE TIERRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2208
Practice Address - Country:US
Practice Address - Phone:787-289-6600
Practice Address - Fax:787-289-6622
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9085207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1216Medicare UPIN
PR83250Medicare ID - Type Unspecified