Provider Demographics
NPI:1891722971
Name:BURGOS PABON, AUREA D (MD)
Entity Type:Individual
Prefix:
First Name:AUREA
Middle Name:D
Last Name:BURGOS PABON
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:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-0745
Mailing Address - Country:US
Mailing Address - Phone:787-739-2440
Mailing Address - Fax:787-739-2440
Practice Address - Street 1:CALLE GAUTIER BENITEZ NUM 19
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-2440
Practice Address - Fax:787-739-2440
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12068208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010599OtherHUMANA INSURANCE
PR3644OtherPREFERRED MEDICARE CHOICE
PRM000426OtherPLAN MENONITA
PR88464OtherTRIPLE S
PRM000426OtherPLAN MENONITA
PR0088464Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER