Healthcare Provider Details

I. General information

NPI: 1659406098
Provider Name (Legal Business Name): JULISA PAREDES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CALLE CARITE URB LAGO ALTO
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

3 SAN RAFAEL ESTS
TRUJILLO ALTO PR
00976-3072
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-7920
  • Fax:
Mailing address:
  • Phone: 787-562-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13578
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: