Provider Demographics
NPI:1619969698
Name:PEGUERO RIVERA, JULIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:A
Last Name:PEGUERO RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIO
Other - Middle Name:A
Other - Last Name:PEGUERO RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0517
Mailing Address - Country:US
Mailing Address - Phone:787-845-2190
Mailing Address - Fax:787-845-2254
Practice Address - Street 1:25 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2618
Practice Address - Country:US
Practice Address - Phone:787-845-2190
Practice Address - Fax:787-845-2254
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82762086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029536Medicare ID - Type UnspecifiedPROVIDER