Provider Demographics
NPI:1508876707
Name:NEGRON, JUANITA (MD)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 AVE LAGUNA
Mailing Address - Street 2:APDO. 602 APT. 611
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6483
Mailing Address - Country:US
Mailing Address - Phone:787-791-6885
Mailing Address - Fax:
Practice Address - Street 1:105 AVE LAGUNA
Practice Address - Street 2:APDO. 602 APT. 611
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6483
Practice Address - Country:US
Practice Address - Phone:787-791-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2017-08-29
Deactivation Date:2017-08-10
Deactivation Code:
Reactivation Date:2017-08-29
Provider Licenses
StateLicense IDTaxonomies
PR12608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics