Healthcare Provider Details

I. General information

NPI: 1295723716
Provider Name (Legal Business Name): LOURDES R. PEDRAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE SUITE 305
SAN JUAN PR
00912-3239
US

IV. Provider business mailing address

252 CALLE SAN JORGE SUITE 305
SAN JUAN PR
00912-3239
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-1185
  • Fax: 787-268-1185
Mailing address:
  • Phone: 787-268-1185
  • Fax: 787-268-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number8153
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: