Provider Demographics
NPI:1982765707
Name:PRIETO AGOSTINI, EDGARDO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:JOSE
Last Name:PRIETO AGOSTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:SUITE 272
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-637-6529
Mailing Address - Fax:787-745-0225
Practice Address - Street 1:AVENIDA JOSE MERCODO ESQUIRE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:COQUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-747-9000
Practice Address - Fax:747-745-0225
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR111662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88639OtherTRIPLE S
PR88639OtherTRIPLE S