Provider Demographics
NPI:1396785556
Name:TOSSAS-MOJICA, MAYLYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MAYLYNN
Middle Name:
Last Name:TOSSAS-MOJICA
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 19813
Mailing Address - Street 2:FERNANDEZ JUNCOS STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1813
Mailing Address - Country:US
Mailing Address - Phone:787-776-6045
Mailing Address - Fax:
Practice Address - Street 1:GO4B AVE. CAMPO RICO
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-776-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF88068Medicare UPIN
PR0083456Medicare ID - Type Unspecified