Basic Information
| Provider Information | |||||||||
| NPI: | 1720197338 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TOMASINI | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | GASTROENTEROLOGIA RCM | ||||||||
| Address2: | PO BOX 29134 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582525 | ||||||||
| FaxNumber: | 7877582583 | ||||||||
| Practice Location | |||||||||
| Address1: | CLINICA DE LA ESCUELA DE MEDICINA | ||||||||
| Address2: | REPARTO METROPOLITANO SHOPPING, AVE. AMERICO MIRANDA | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877587910 | ||||||||
| FaxNumber: | 7876251966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 2766 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | AT4224767 | 01 | DEA | OTHER |