Provider Demographics
NPI:1437125713
Name:MAIZ, ROBERTO E (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:E
Last Name:MAIZ
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 1585
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-5585
Mailing Address - Country:US
Mailing Address - Phone:787-849-2531
Mailing Address - Fax:787-892-9290
Practice Address - Street 1:100 CALLE HERNAN ALVAREZ
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4173
Practice Address - Country:US
Practice Address - Phone:787-892-3318
Practice Address - Fax:787-892-9290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12998208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH51096Medicare UPIN