Healthcare Provider Details

I. General information

NPI: 1487840302
Provider Name (Legal Business Name): PEDRO FEDERICO BERDEGUER-DE LEON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962-B, SAN SALVADOR ST. URB. LAS AMERICAS
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 1097
MINNEOLA FL
34755-1097
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-3740
  • Fax:
Mailing address:
  • Phone: 787-274-8126
  • Fax: 352-243-3740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number05727
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: