Provider Demographics
NPI:1366438434
Name:GENAO ENCARNACION, MAXUEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MAXUEL
Middle Name:E
Last Name:GENAO ENCARNACION
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:PO BOX 50027
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0027
Mailing Address - Country:US
Mailing Address - Phone:787-785-2694
Mailing Address - Fax:787-787-3109
Practice Address - Street 1:ZA1 CALLE 36
Practice Address - Street 2:URB. RIVERVIEW
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3929
Practice Address - Country:US
Practice Address - Phone:787-785-2694
Practice Address - Fax:787-787-3109
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11201208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87629OtherTRIPLE-S
PR87629OtherTRIPLE-S