1992714133 NPI number — PEDRO P PAEZ GONZALEZ MD

Table of content: PEDRO P PAEZ GONZALEZ MD (NPI 1992714133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992714133 NPI number — PEDRO P PAEZ GONZALEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAEZ GONZALEZ
Provider First Name:
PEDRO
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1992714133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 190464
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00919 0464
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-725-8534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ASHFORD MEDICAL CENTER #29 CALLE WASHINGTON
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PUERTO RICO
Provider Business Practice Location Address Postal Code:
00907 1503
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-725-8534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  8815 , 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: 88060 . This is a "TRIPLE S PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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