Provider Demographics
NPI:1831197037
Name:SOSA-PADILLA, MIGUEL (MD)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:SOSA-PADILLA
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 1:1539 CALLE PARANA
Mailing Address - Street 2:URB. EL PARAISO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2832
Mailing Address - Country:US
Mailing Address - Phone:787-764-8281
Mailing Address - Fax:787-764-8218
Practice Address - Street 1:1539 CALLE PARANA
Practice Address - Street 2:URB. EL PARAISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2832
Practice Address - Country:US
Practice Address - Phone:787-764-8281
Practice Address - Fax:787-764-8218
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7627208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
80364Medicare ID - Type Unspecified
C77767Medicare UPIN