Provider Demographics
NPI:1215901426
Name:AGOSTO-MUJICA, ANARDI (MD)
Entity type:Individual
Prefix:DR
First Name:ANARDI
Middle Name:
Last Name:AGOSTO-MUJICA
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 1:75 CALLE EUSEBIO ITURRINO
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3221
Mailing Address - Country:US
Mailing Address - Phone:787-635-4374
Mailing Address - Fax:787-905-7908
Practice Address - Street 1:109 JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-9000
Practice Address - Country:US
Practice Address - Phone:787-635-4374
Practice Address - Fax:787-905-7908
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15888207K00000X, 207R00000X, 208000000X
FLME93943207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273367600Medicaid
28690OtherBLUE CROSS BLUE SHIELD