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General NPI Number Information
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NPI Number | 1477687564
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Entity Type | Individual
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Provider Name | IDALIA PEDROZA-LOPEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 201 CALLE GAUTIER BENITEZ SUITE 201
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City | CAGUAS
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State | PR
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Zip | 00725-5527
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Country | US
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Telephone | 787-743-1699
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Fax | 787-258-1517
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Provider Business Mailing Address
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Address Line | PO BOX 6735
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City | CAGUAS
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State | PR
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Zip | 00726-6735
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Country | US
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Telephone | 787-743-1699
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Fax | 787-258-1517
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 12214
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License Number State | PR
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