Provider Demographics
NPI:1750386652
Name:HADDAD, MARIO A (MD)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:A
Last Name:HADDAD
Suffix:
Gender:M
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 1969
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1969
Mailing Address - Country:US
Mailing Address - Phone:787-767-7885
Mailing Address - Fax:787-767-5626
Practice Address - Street 1:TORRE AUXILIO MUTUO SUITE 413
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-767-7885
Practice Address - Fax:787-767-5626
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE66545Medicare UPIN
PR80418Medicare ID - Type Unspecified