Provider Demographics
NPI:1487840302
Name:BERDEGUER-DE LEON, PEDRO FEDERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:FEDERICO
Last Name:BERDEGUER-DE LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34755-1097
Mailing Address - Country:US
Mailing Address - Phone:787-274-8126
Mailing Address - Fax:352-243-3740
Practice Address - Street 1:962-B, SAN SALVADOR ST.
Practice Address - Street 2:URB. LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:352-243-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05727207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery