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General NPI Number Information
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NPI Number | 1164918223
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Entity Type | Individual
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Provider Name | CARLOS RONALD PEDRAZA GONZALEZ MD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | CARR 2 KM 141.1 AVE SEVERIANO CUEVAS
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-658-0200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2304
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City | MOCA
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State | PR
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Zip | 00676-2304
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Country | US
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Telephone | 787-415-3408
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 21590
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License Number State | PR
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