Provider Demographics
NPI:1891793774
Name:LINARES, MAXIMINO (MD)
Entity type:Individual
Prefix:
First Name:MAXIMINO
Middle Name:
Last Name:LINARES
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:KK16 CALLE OLIMPO
Mailing Address - Street 2:URB. APOLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5022
Mailing Address - Country:US
Mailing Address - Phone:787-731-1414
Mailing Address - Fax:
Practice Address - Street 1:503 CALLE EMILIANO POL
Practice Address - Street 2:URB. LA CUMBRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-731-1414
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8117208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-9677Medicare UPIN
PR066575Medicare UPIN