Provider Demographics
NPI:1457544561
Name:JUAN, PABLO (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:JUAN
Suffix:
Gender:M
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:PASEO DEL PRADO C 7 CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-646-4732
Mailing Address - Fax:787-283-3266
Practice Address - Street 1:C7 CAMINO REAL
Practice Address - Street 2:PASEO DEL PRADO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5906
Practice Address - Country:US
Practice Address - Phone:787-646-4732
Practice Address - Fax:787-283-3266
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist