Provider Demographics
NPI:1154386274
Name:SAN ANTONIO PINEIRO, ADA MANA (MD)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:MANA
Last Name:SAN ANTONIO PINEIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:URB SABANERA
Mailing Address - Street 2:CAMINO LOS HELECHES 429
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-714-0058
Mailing Address - Fax:787-293-0589
Practice Address - Street 1:ACUANO STREET 19
Practice Address - Street 2:VENUS GARDEN PLAZA SUITE 4
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-293-0505
Practice Address - Fax:787-293-0505
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR13139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H41973Medicare UPIN
PR84097Medicare ID - Type Unspecified