Altagracia Fullana, M.D. – Pediatrics Physician

Key facts

NPI: 1922301985
Entity type: Individual (NPI type 1)
Primary specialty: Pediatrics Physician 208000000X
License: 11255 (PR)
Practice address: Calle Hernandez Carrion
Manati Medical Center, Suite 206
Manati, PR 00674
Phone: (787) 854-3249
Fax: (787) 854-2613
NPI assigned: Dec 14, 2010
Sex: Female
Sole proprietor: No

Organizations & group practices 2

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.

Dorado Health Inc General Acute Care Hospital · Manati, PR · NPI 1376605170

NPD (past)
Team OB-GYN, PSC Specialist · Manati, PR · NPI 1740688696

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
11255	PR	MD	Pediatrics Physician

Practice roles

Organization	Specialty	Status	New patients
Dorado Health Inc		Past	Accepting new patients
Team OB-GYN, PSC		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatrics Physician	208000000X	11255	PR	Yes

Addresses

Primary practice location

Calle Hernandez Carrion
Manati Medical Center, Suite 206
Manati, PR 00674

Mailing address

PO Box 1020
Manati, PR 00674-1020
Phone (787) 854-3249

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 18, 2012.

{
    "created_epoch": "1292284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337299200000",
    "number": "1922301985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1020",
            "city": "MANATI",
            "state": "PR",
            "postal_code": "006741020",
            "telephone_number": "787-854-3249",
            "fax_number": "787-854-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE HERNANDEZ CARRION",
            "address_2": "MANATI MEDICAL CENTER, SUITE 206",
            "city": "MANATI",
            "state": "PR",
            "postal_code": "00674",
            "telephone_number": "787-854-3249",
            "fax_number": "787-854-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLANA",
        "first_name": "ALTAGRACIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-14",
        "last_updated": "2012-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PR",
            "license": "11255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manati, PR

All providers in Manati, PR · Pediatrics Physician in Puerto Rico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2012. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.