Provider Demographics
NPI:1215918164
Name:OJEDA, IRIVETTE (MD)
Entity type:Individual
Prefix:
First Name:IRIVETTE
Middle Name:
Last Name:OJEDA
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:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0652
Mailing Address - Country:US
Mailing Address - Phone:787-254-3410
Mailing Address - Fax:787-254-3410
Practice Address - Street 1:25 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4029
Practice Address - Country:US
Practice Address - Phone:787-254-3410
Practice Address - Fax:787-254-3410
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12805174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090184Medicare ID - Type UnspecifiedPROVIDER NUMBER