MEDICARE: SANDRA T. BERDECIA 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	207R00000X	Internal Medicine Physician	12679	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12679	OTHER	PR	STATE LICENSE

General Provider Information

NPI Number	:	1861497869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA T. BERDECIA MD

Provider Business Mailing Address
First Line	:	PO BOX 194882
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-4882
Country	:	US
Telephone Number	:	787-753-3024
Fax Number	:	787-753-3026

Provider Business Practice Location Address
First Line	:	112 CALLE ARZUAGA
Second Line	:	OFICINA 902
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00925-3321
Country	:	US
Telephone Number	:	787-753-3024
Fax Number	:	787-753-3026

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	05/02/2025

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