Basic Information
| Provider Information | |||||||||
| NPI: | 1174589139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WISCOVITCH | ||||||||
| FirstName: | ADANETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MONTEHEIDRA TOWN CTR | ||||||||
| Address2: | 53 FALCON ST. | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009267007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877311346 | ||||||||
| FaxNumber: | 7877717996 | ||||||||
| Practice Location | |||||||||
| Address1: | PONCE DE LEON AVE AUXILIO MUTUO | ||||||||
| Address2: | PDA 37 1/2 | ||||||||
| City: | HATO REY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582000 | ||||||||
| FaxNumber: | 7877717996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 9670 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
No ID Information.