Provider Demographics
NPI:1679632756
Name:MOJICA MANOSA, PABLO (MD)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:
Last Name:MOJICA MANOSA
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 1:362 CAMINO DE LOS LAURELES
Mailing Address - Street 2:SABANERA DEL RIO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5250
Mailing Address - Country:US
Mailing Address - Phone:787-744-2052
Mailing Address - Fax:
Practice Address - Street 1:208 AVE PONCE DE LEON # 715
Practice Address - Street 2:PARADA 37
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1000
Practice Address - Country:US
Practice Address - Phone:787-771-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA907802086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A907800Medicaid
CAWA90780AMedicare ID - Type Unspecified
I35433Medicare UPIN