Individual provider Active NPI

Julio Cesar Mantero Hormazabal, M.D.

  • Internal Medicine Physician
  • Bayamon, PR
National Provider Identifier
1124024542
Registry record updated May 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
8555 Issued in PR
Practice address
1845 Carr 2
Ste 606
Bayamon, PR 00959-7204
Phone
(787) 798-1645
Fax
(787) 798-1604
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 8555 PR Primary

Addresses

Primary practice location

1845 Carr 2
Ste 606
Bayamon, PR 00959-7204

Mailing address

154 Calle Cola de Pescado
Guaynabo, PR 00969-5818
Phone (787) 798-1645

Other identifiers 1

IdentifierTypeStateIssuer
8555OtherPRSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050815000573 PR Practitioner - Internal Medicine 1951331438 Practice locations: Bayamon, PR

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1845 Carr
Suite 606
Bayamon, PR 00959-7204
Phone (787) 798-1645

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
8555PRMDPharmacy Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495584000000",
    "number": "1124024542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 CALLE COLA DE PESCADO",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "009695818",
            "telephone_number": "787-798-1645",
            "fax_number": "787-798-1604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 CARR 2",
            "address_2": "STE 606",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009597204",
            "telephone_number": "787-798-1645",
            "fax_number": "787-798-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTERO HORMAZABAL",
        "first_name": "JULIO",
        "middle_name": "CESAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2017-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PR",
            "license": "8555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "8555",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayamon, PR

Sources for this page

Verify at the official NPI Registry.