MEDICARE: DRES. PEGUERO E IGUINA

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	208D00000X	General Practice Physician	8244	PR

General Provider Information

NPI Number	:	1902067945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRES. PEGUERO E IGUINA

Provider Business Mailing Address
First Line	:	PO BOX 517
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-0517
Country	:	US
Telephone Number	:	787-845-2190
Fax Number	:	787-845-2254

Provider Business Practice Location Address
First Line	:	25 CALLE BETANCES
Second Line	:
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-2618
Country	:	US
Telephone Number	:	787-845-2190
Fax Number	:	787-845-2254

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. MARIA DEL CARMEN IGUINA
Credential	:	M.D.
Telephone Number	:	787-845-2190

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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