Healthcare Provider Details

I. General information

NPI: 1508876707
Provider Name (Legal Business Name): JUANITA NEGRON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date: 08/10/2017
Reactivation Date: 08/29/2017

III. Provider practice location address

105 AVE LAGUNA APDO. 602 APT. 611
CAROLINA PR
00979-6483
US

IV. Provider business mailing address

105 AVE LAGUNA APDO. 602 APT. 611
CAROLINA PR
00979-6483
US

V. Phone/Fax

Practice location:
  • Phone: 787-791-6885
  • Fax:
Mailing address:
  • Phone: 787-791-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12608
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: