Provider Demographics
NPI:1487053385
Name:AGOSTO MUJICA, ANARDI AUGUSTO (MD)
Entity type:Individual
Prefix:
First Name:ANARDI
Middle Name:AUGUSTO
Last Name:AGOSTO MUJICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANARDI
Other - Middle Name:AUGUSTO
Other - Last Name:AGOSTO MUJICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:BO MONACILLO CENTRO MEDICO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935-0001
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:
Practice Address - Street 1:109 AVE JOSE DE DIEGO E
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3822
Practice Address - Country:US
Practice Address - Phone:787-366-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21192207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism