Provider Demographics
NPI:1962631713
Name:NEGRON NEGRON, ILSA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ILSA
Middle Name:M
Last Name:NEGRON NEGRON
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:P2 CALLE SANTA MARTA
Mailing Address - Street 2:URB. SANTA ELVIRA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-202-9258
Mailing Address - Fax:
Practice Address - Street 1:P2 CALLE SANTA MARTA
Practice Address - Street 2:URB.SANTA ELVIRA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3481
Practice Address - Country:US
Practice Address - Phone:787-202-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17634208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice