Healthcare Provider Details

I. General information

NPI: 1588633713
Provider Name (Legal Business Name): HECTOR L PESQUERA SEVILLANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 AVE ROOSEVELT PUERTO NUEVO
SAN JUAN PR
00920-2904
US

IV. Provider business mailing address

K3 AVE CARBONELL VERSALLES
BAYAMON PR
00959-2145
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-8272
  • Fax:
Mailing address:
  • Phone: 787-781-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5470
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: