Healthcare Provider Details

I. General information

NPI: 1629059621
Provider Name (Legal Business Name): PEDRO RAFAEL ESCALONA LOUBRIEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#416 CALLE BETANCES(POST)
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

268 CALLE MIRAMAR
MAYAGUEZ PR
00682-5836
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-2250
  • Fax:
Mailing address:
  • Phone: 787-265-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8122
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: