Provider Demographics
NPI:1316310733
Name:MISAEL TOLLEN
Entity type:Organization
Organization Name:MISAEL TOLLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL EVALUATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MISAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-951-3632
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1083
Mailing Address - Country:US
Mailing Address - Phone:787-951-3632
Mailing Address - Fax:
Practice Address - Street 1:CALLE 312
Practice Address - Street 2:HOSPITAL METROPOLITANO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-951-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19195208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty