Healthcare Provider Details

I. General information

NPI: 1790840312
Provider Name (Legal Business Name): MARIA F PARDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CALLE CARITE URB. LAGO ALTO K.M. 4.7
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

544 CALLE ORQUIDEA URB. ROUND HILL
TRUJILLO ALTO PR
00976-2714
US

V. Phone/Fax

Practice location:
  • Phone: 787-760-6269
  • Fax:
Mailing address:
  • Phone: 787-240-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10577
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: