Provider Demographics
NPI:1881403004
Name:PERALTA PACHECO, YUDERKA A (MD)
Entity type:Individual
Prefix:
First Name:YUDERKA
Middle Name:A
Last Name:PERALTA PACHECO
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:URB COUNTRY CLUB
Mailing Address - Street 2:1125 CARLOS BERTERO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-949-7846
Mailing Address - Fax:
Practice Address - Street 1:URB COUNTRY CLUB
Practice Address - Street 2:1125 CARLOS BERTERO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-949-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24216208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice