Provider Demographics
NPI:1134154859
Name:RECART, JOHANA (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANA
Middle Name:
Last Name:RECART
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 250476
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0476
Mailing Address - Country:US
Mailing Address - Phone:787-891-7497
Mailing Address - Fax:
Practice Address - Street 1:CARR. 107 KM. 2.8
Practice Address - Street 2:BO. BORINQUEN
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHT161AOtherMEDICARE
PR7436OtherLICENCIA