Provider Demographics
NPI:1215097258
Name:COIMBRE CARTAGONA, EDWIN SR (MD)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:COIMBRE CARTAGONA
Suffix:SR
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:P O BOX 1865, COAMO PUERTO RICO 00769
Mailing Address - Street 2:CALLE JOSE I QUINTON, COAMO PUERTO RICO 00769
Mailing Address - City:COAMO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00769
Mailing Address - Country:UM
Mailing Address - Phone:787-825-0643
Mailing Address - Fax:787-825-2352
Practice Address - Street 1:65 CALLE JOSE I QUINTON # 769
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3105
Practice Address - Country:US
Practice Address - Phone:787-825-0643
Practice Address - Fax:787-825-2352
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
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