Healthcare Provider Details

I. General information

NPI: 1932555489
Provider Name (Legal Business Name): IVETTE MARIE SIERRA ESPADA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO RICON SEC. LOMAS CARR. PR #14 KM.1.2
CAYEY PR
00737
US

IV. Provider business mailing address

PO BOX 372800
CAYEY PR
00737-2800
US

V. Phone/Fax

Practice location:
  • Phone: 787-535-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21206
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: