Provider Demographics
NPI:1750464244
Name:PRIETO, MARIA C (OD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:PRIETO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DEL C
Other - Last Name:PRIETO-FERRER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:EL REMANSO
Mailing Address - Street 2:C-10 ARROYO ST.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-398-0463
Mailing Address - Fax:
Practice Address - Street 1:SANTA ROSA MALL LOCAL #7
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR196395Medicare UPIN