Provider Demographics
NPI:1922048263
Name:PRATTS, IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:PRATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SELENIA
Other - Middle Name:IVETTE
Other - Last Name:PRATTS-PONCE DE LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3103 AVE. ISLA VERDE
Mailing Address - Street 2:APT. 504
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4943
Mailing Address - Country:US
Mailing Address - Phone:787-403-9699
Mailing Address - Fax:787-762-3561
Practice Address - Street 1:3103 AVE. ISLA VERDE
Practice Address - Street 2:APT. 504
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-4943
Practice Address - Country:US
Practice Address - Phone:787-403-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4035208100000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24621Medicare ID - Type Unspecified
PRD33434Medicare UPIN