Provider Demographics
NPI:1013119304
Name:BRITO PEQUERA, YUDIT MAYTEE
Entity Type:Individual
Prefix:DR
First Name:YUDIT
Middle Name:MAYTEE
Last Name:BRITO PEQUERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CALLE CENTAURO
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4027
Mailing Address - Country:US
Mailing Address - Phone:787-967-6769
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:STE 715
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5030
Practice Address - Country:US
Practice Address - Phone:787-967-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15546208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15546OtherLICENSE #
PR15799 D.M.-O (P-R)OtherLOCAL
PRBB9253662OtherDEA REG. NO.