MEDICARE: DR. LOURDES R. PEDRAZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0214X	Pediatric Pulmonology Physician	8153	PR

General Provider Information

NPI Number	:	1295723716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOURDES R. PEDRAZA MD

Provider Business Mailing Address
First Line	:	252 CALLE SAN JORGE
Second Line	:	SUITE 305
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3239
Country	:	US
Telephone Number	:	787-268-1185
Fax Number	:	787-268-1185

Provider Business Practice Location Address
First Line	:	252 CALLE SAN JORGE
Second Line	:	SUITE 305
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3239
Country	:	US
Telephone Number	:	787-268-1185
Fax Number	:	787-268-1185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	04/06/2012

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