Individual provider Active NPI

Lorenzo E Bosque Hernandez, MD

  • General Practice Physician
  • San Juan, PR
National Provider Identifier
1407850175
Registry record updated Oct 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
10796 Issued in PR
Practice address
145 Calle Guaraguao
San Juan, PR 00926-7101
Phone
(787) 760-6604
Fax
(787) 292-0130
NPI assigned
Jun 9, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 10796 PR Primary

Addresses

Primary practice location

145 Calle Guaraguao
San Juan, PR 00926-7101

Mailing address

145 Calle Guaraguao
San Juan, PR 00926-7101
Phone (787) 760-6604

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
I20050509000499 PR Practitioner - General Practice 2567366990 Practice locations: San Juan, PR

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10796PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prestige Medical Group Ljcpsc PastSince Nov 14, 2007 Accepting new patients
Reitter Corporation PastSince Mar 31, 1990 Accepting new patients
GMS Medical Group P S C General Practice Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254787200000",
    "number": "1407850175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 CALLE GUARAGUAO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009267101",
            "telephone_number": "787-760-6604",
            "fax_number": "787-292-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 CALLE GUARAGUAO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009267101",
            "telephone_number": "787-760-6604",
            "fax_number": "787-292-0130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSQUE HERNANDEZ",
        "first_name": "LORENZO",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2009-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "10796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.