Provider Demographics
NPI:1356467559
Name:PIETRI, WALESKA (MD)
Entity Type:Individual
Prefix:
First Name:WALESKA
Middle Name:
Last Name:PIETRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:119 CALLEJON PATIO ROSA
Mailing Address - Street 2:BO. PAMPANOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0346
Mailing Address - Country:US
Mailing Address - Phone:787-642-0964
Mailing Address - Fax:787-840-2317
Practice Address - Street 1:119 CALLEJON PATIO ROSA
Practice Address - Street 2:BO. PAMPANOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0346
Practice Address - Country:US
Practice Address - Phone:787-642-0964
Practice Address - Fax:787-840-2317
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR10588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG50690Medicare UPIN
PRG50690Medicare UPIN