Provider Demographics
NPI:1801863063
Name:JURADO-AGOSTO, ZULMA IRIS (MD)
Entity Type:Individual
Prefix:
First Name:ZULMA
Middle Name:IRIS
Last Name:JURADO-AGOSTO
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:P.O. BOX 10,000 PMB 445
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0011
Mailing Address - Country:US
Mailing Address - Phone:787-256-0132
Mailing Address - Fax:787-256-0132
Practice Address - Street 1:CALLE PALMER, ESQ. BLANCO SOSA #18
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-856-0132
Practice Address - Fax:787-256-0132
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40962Medicare UPIN