Provider Demographics
NPI:1477687564
Name:PEDROZA-LOPEZ, IDALIA (MD)
Entity Type:Individual
Prefix:DR
First Name:IDALIA
Middle Name:
Last Name:PEDROZA-LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IDALIA
Other - Middle Name:
Other - Last Name:PEDROZA-LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41270Medicare UPIN