Healthcare Provider Details

I. General information

NPI: 1306717509
Provider Name (Legal Business Name): PELET OB-GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 140 KM 60.9 BO MAGUEYES
BARCELONETA PR
00617
US

IV. Provider business mailing address

HC 3 BOX 3336
FLORIDA PR
00650-9796
US

V. Phone/Fax

Practice location:
  • Phone: 787-408-7627
  • Fax:
Mailing address:
  • Phone: 787-408-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: INDIRA JUDITH PELET RIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-408-7627