Provider Demographics
NPI:1356475479
Name:CONSULTORIO MEDICO DRS. VIERA Y PEDROZA, CSP
Entity Type:Organization
Organization Name:CONSULTORIO MEDICO DRS. VIERA Y PEDROZA, CSP
Other - Org Name:CONSULTORIO MEDICO DRS. VIERA Y PEDROZA, CSP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:VIERA-VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-743-1699
Mailing Address - Street 1:PO BOX 6735
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6735
Mailing Address - Country:US
Mailing Address - Phone:787-743-1699
Mailing Address - Fax:787-258-1517
Practice Address - Street 1:201 CALLE GAUTIER BENITEZ
Practice Address - Street 2:SUITE 201
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5527
Practice Address - Country:US
Practice Address - Phone:787-743-1699
Practice Address - Fax:787-258-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE09389Medicare UPIN