Provider Demographics
NPI:1104810373
Name:FADUL PAULINO, YESMIN (MD)
Entity type:Individual
Prefix:
First Name:YESMIN
Middle Name:
Last Name:FADUL PAULINO
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 1:471 VIA MARBELLA
Mailing Address - Street 2:URB PASEO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4646
Mailing Address - Country:US
Mailing Address - Phone:787-261-7659
Mailing Address - Fax:787-778-1567
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:SANTA CRUZ MEDICAL BLDG STE 409
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-778-1567
Practice Address - Fax:787-778-1567
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15138208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99109Medicare UPIN
PRFA22009Medicare ID - Type Unspecified