Provider Demographics
NPI:1730541327
Name:EMMANUELLI, ADRIANA SOFIA (MD)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:SOFIA
Last Name:EMMANUELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 AVE PONCE DE LEON APT 705
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3351
Mailing Address - Country:US
Mailing Address - Phone:787-238-2959
Mailing Address - Fax:
Practice Address - Street 1:EXT VILLAMAR
Practice Address - Street 2:1025 MARGINAL VILLAMAR
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-0097
Practice Address - Country:US
Practice Address - Phone:787-726-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138753207Q00000X
390200000X
PR21832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program