Provider Demographics
NPI:1295783793
Name:BEAUREGARD, LOURDES NATALIA (OD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:NATALIA
Last Name:BEAUREGARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193128
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3128
Mailing Address - Country:US
Mailing Address - Phone:787-758-2404
Mailing Address - Fax:787-758-4227
Practice Address - Street 1:AVE. TENIENTE CESAR GONZALEZ #572
Practice Address - Street 2:URB. BALDRICH
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-758-2404
Practice Address - Fax:787-758-4227
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU-26550Medicare UPIN
PR005-8088Medicare ID - Type UnspecifiedOPTOMETRIST