Provider Demographics
NPI:1083826754
Name:BEZARES, SANDRA ENID (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ENID
Last Name:BEZARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1133
Mailing Address - Country:US
Mailing Address - Phone:787-745-1523
Mailing Address - Fax:
Practice Address - Street 1:BAIROA SHOPPING CENTER CARR#1
Practice Address - Street 2:SUITE#12
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-704-6299
Practice Address - Fax:787-704-6299
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F13819Medicare UPIN
PR20300Medicare ID - Type Unspecified