Provider Demographics
NPI:1730149808
Name:MENJIVAR, ROBERTO A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:A
Last Name:MENJIVAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:SABANERA STREET FINQUITAS DEL MONTE
Mailing Address - Street 2:#312
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-421-0454
Mailing Address - Fax:
Practice Address - Street 1:DOCTORS' CENTER HOSPITAL
Practice Address - Street 2:1395 CALLE SAN RAFAEL
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-999-7620
Practice Address - Fax:787-725-2124
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice