Provider Demographics
NPI:1275576662
Name:PEZZOTTI, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:PEZZOTTI
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 1:2 CALLE SEVILLA
Mailing Address - Street 2:TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3018
Mailing Address - Country:US
Mailing Address - Phone:787-460-3561
Mailing Address - Fax:787-277-0105
Practice Address - Street 1:1035 AVE ASHFORD
Practice Address - Street 2:SUITE C-1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1162
Practice Address - Country:US
Practice Address - Phone:787-460-3561
Practice Address - Fax:787-721-0721
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR008848208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR008848OtherMEDICAL LICENSE