1194857433 NPI number — DR. GERARDO ANTONIO PEDROZA SIERRA

Table of content: (NPI 1194857433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194857433 NPI number — DR. GERARDO ANTONIO PEDROZA SIERRA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. GERARDO ANTONIO PEDROZA SIERRA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194857433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COLINAS DE BAYAMON
Provider Second Line Business Mailing Address:
250 831 RD. APT. 810
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-785-5968
Provider Business Mailing Address Fax Number:
787-785-5968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDF. MEDICO HNAS. DAVILA
Provider Second Line Business Practice Location Address:
CALLE 2 ESQ. B OFICINA 101
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-785-5968
Provider Business Practice Location Address Fax Number:
787-785-5968
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEDROZA-SIERRA
Authorized Official First Name:
GERARDO
Authorized Official Middle Name:
ANTONIO
Authorized Official Title or Position:
GENERAL PHYSICIAN
Authorized Official Telephone Number:
787-785-5968

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  15516 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23116-PE . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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