Healthcare Provider Details

I. General information

NPI: 1619969698
Provider Name (Legal Business Name): JULIO A. PEGUERO RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JULIO A. PEGUERO RIVERA M.D.

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CALLE BETANCES
SANTA ISABEL PR
00757-2618
US

IV. Provider business mailing address

PO BOX 517
SANTA ISABEL PR
00757-0517
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-2190
  • Fax: 787-845-2254
Mailing address:
  • Phone: 787-845-2190
  • Fax: 787-845-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number8276
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: