Provider Demographics
NPI:1275820367
Name:OQUENDO, PEDRO J
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:J
Last Name:OQUENDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5348
Mailing Address - Country:US
Mailing Address - Phone:786-523-1068
Mailing Address - Fax:
Practice Address - Street 1:5300 NW 77TH CT
Practice Address - Street 2:SUIT 201
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4110
Practice Address - Country:US
Practice Address - Phone:786-523-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA59742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist