Provider Demographics
NPI:1891831046
Name:MOJICA-COSME, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:MOJICA-COSME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ANTONIO
Other - Middle Name:
Other - Last Name:MOJICA-COSME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4291
Mailing Address - Street 2:BAYAMON GARDENS STATION
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1291
Mailing Address - Country:US
Mailing Address - Phone:787-869-4307
Mailing Address - Fax:
Practice Address - Street 1:RD 152 KM 12.9
Practice Address - Street 2:CEDRO ARRIBA
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE33821Medicare UPIN
PR0082337Medicare PIN