Provider Demographics
NPI:1104018654
Name:TRABANCO, CESAR H (MD)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:H
Last Name:TRABANCO
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 10578
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0578
Mailing Address - Country:US
Mailing Address - Phone:787-841-7168
Mailing Address - Fax:787-840-1552
Practice Address - Street 1:1006 PARRA MEDICAL INSTITUTE 2225 PONCE BY PASS
Practice Address - Street 2:SUITE 1006
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1382
Practice Address - Country:US
Practice Address - Phone:787-840-8686
Practice Address - Fax:787-840-1552
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7904207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81371OtherMEDICARE & SSS
PRE20101Medicare UPIN