Healthcare Provider Details

I. General information

NPI: 1114031861
Provider Name (Legal Business Name): CLERY HEUGHES PASCUAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 AVENIDA CAMPO RICO COUNTRY CLUB
SAN JUAN PR
00924
US

IV. Provider business mailing address

776 AVENIDA CAMPO RICO COUNTRY CLUB
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-1774
  • Fax:
Mailing address:
  • Phone: 787-768-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15070
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: