Provider Demographics
NPI:1992772099
Name:MAYOL-URDAZ, MAGDIEL (MD)
Entity type:Individual
Prefix:
First Name:MAGDIEL
Middle Name:
Last Name:MAYOL-URDAZ
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:VISTA LOS FRAILES
Mailing Address - Street 2:150 CARR.873, APT.74
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5157
Mailing Address - Country:US
Mailing Address - Phone:787-356-7175
Mailing Address - Fax:787-620-4636
Practice Address - Street 1:CEPYQ-HOSPITAL SAN FRANCISCO
Practice Address - Street 2:371 DE DIEGO AVE.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-767-5100
Practice Address - Fax:787-620-4636
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14248207XX0801X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022559Medicare ID - Type Unspecified
PRI16447Medicare UPIN