Provider Demographics
NPI:1194857433
Name:DR. GERARDO ANTONIO PEDROZA SIERRA
Entity type:Organization
Organization Name:DR. GERARDO ANTONIO PEDROZA SIERRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PEDROZA-SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-785-5968
Mailing Address - Street 1:COLINAS DE BAYAMON
Mailing Address - Street 2:250 831 RD. APT. 810
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-785-5968
Mailing Address - Fax:787-785-5968
Practice Address - Street 1:EDF. MEDICO HNAS. DAVILA
Practice Address - Street 2:CALLE 2 ESQ. B OFICINA 101
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-785-5968
Practice Address - Fax:787-785-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15516261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23116-PEOtherTRIPLE S
PR0023116Medicare ID - Type UnspecifiedMEDICARE B
PRI-33667Medicare UPIN