Provider Demographics
NPI:1285637629
Name:PIETRI, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:PIETRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1515
Mailing Address - Country:US
Mailing Address - Phone:787-991-1560
Mailing Address - Fax:787-991-1560
Practice Address - Street 1:102 RAMON FLORES ST.
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3716
Practice Address - Country:US
Practice Address - Phone:787-991-1560
Practice Address - Fax:787-991-1560
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR466171100000X
PR14885208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021812Medicare ID - Type UnspecifiedMEDICARE #
PRH98285Medicare UPIN