Healthcare Provider Details

I. General information

NPI: 1114637626
Provider Name (Legal Business Name): PEDRO ANDRES OLIVER SEGARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 335194
PONCE PR
00733-5194
US

V. Phone/Fax

Practice location:
  • Phone: 787-604-2819
  • Fax:
Mailing address:
  • Phone: 787-604-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23065
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: