Provider Demographics
NPI:1689646408
Name:STODDARD LATORRE, HAROLD NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:NELSON
Last Name:STODDARD LATORRE
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 19536
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1536
Mailing Address - Country:US
Mailing Address - Phone:787-977-0707
Mailing Address - Fax:787-977-0708
Practice Address - Street 1:1519 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 1105
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00910
Practice Address - Country:AX
Practice Address - Phone:787-977-0707
Practice Address - Fax:787-977-0708
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12024207R00000X
PR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12024OtherMEDICAL LICENSE
PR2-0674Medicare ID - Type Unspecified
PR12024OtherMEDICAL LICENSE