MEDICARE: DEIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1437013596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEIDA LLC

Provider Business Mailing Address
First Line	:	URB VILLA FLORENCIA 27
Second Line	:
City	:	CAMUY
State	:	PR
Zip	:	00627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	F1 AVE ANTONIO R BARCELO
Second Line	:
City	:	CAYEY
State	:	PR
Zip	:	00736-3765
Country	:	US
Telephone Number	:	787-247-6056
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	NATALLIE JUDITH DEIDA PEREZ
Credential	:	MD
Telephone Number	:	787-247-6056

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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