Provider Demographics
NPI:1629272661
Name:PEDRAZA-ROSA, GRISEL MARIE (MD)
Entity Type:Individual
Prefix:
First Name:GRISEL
Middle Name:MARIE
Last Name:PEDRAZA-ROSA
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:DEPT. ANESTESIOLOGIA RCM
Mailing Address - Street 2:PO BOX 365067
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-758-0640
Mailing Address - Fax:787-758-1327
Practice Address - Street 1:ANESTESIA RCM
Practice Address - Street 2:APARTADO 29134
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929-0134
Practice Address - Country:US
Practice Address - Phone:787-758-0640
Practice Address - Fax:787-758-1327
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15655207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15655OtherLIC