Provider Demographics
NPI:1689600678
Name:LICEAGA SANCHEZ, JUAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:B
Last Name:LICEAGA SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 ISABELA BEACH CT
Mailing Address - Street 2:APT. 244
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2418
Mailing Address - Country:US
Mailing Address - Phone:787-872-4141
Mailing Address - Fax:787-872-4141
Practice Address - Street 1:7124 AVENIDA AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2419
Practice Address - Country:US
Practice Address - Phone:787-872-4141
Practice Address - Fax:787-872-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14526208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice