Healthcare Provider Details

I. General information

NPI: 1043219801
Provider Name (Legal Business Name): SYLVETTE G. PETERSON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 107
AGUADILLA PR
00603-5970
US

IV. Provider business mailing address

PO BOX 717
MOCA PR
00676-0717
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-4280
  • Fax: 787-882-4280
Mailing address:
  • Phone: 787-882-4280
  • Fax: 787-882-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0037
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: