Provider Demographics
NPI:1740387034
Name:BOSCHETTI, MILDRED (MD)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:BOSCHETTI
Suffix:
Gender:F
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:G-1 CALLE 2
Mailing Address - Street 2:EXT. VILLA RICA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5030
Mailing Address - Country:US
Mailing Address - Phone:787-475-7773
Mailing Address - Fax:
Practice Address - Street 1:G-1 CALLE 2
Practice Address - Street 2:EXT. VILLA RICA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5030
Practice Address - Country:US
Practice Address - Phone:787-778-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10413208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice