Provider Demographics
NPI:1942285747
Name:ANDUJAR, ALTAGRACIA E (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALTAGRACIA
Middle Name:E
Last Name:ANDUJAR
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 588
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0588
Mailing Address - Country:US
Mailing Address - Phone:787-896-1189
Mailing Address - Fax:787-896-1189
Practice Address - Street 1:CALLE HIPOLITO CASTRO #27
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0588
Practice Address - Country:US
Practice Address - Phone:787-896-1189
Practice Address - Fax:787-896-1189
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3308208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79340Medicare UPIN
23927Medicare ID - Type Unspecified