Provider Demographics
NPI:1306973706
Name:SEDA, JEANNETTE (MT)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:
Last Name:SEDA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE FRANCISOCO GONZALEZ M 12
Mailing Address - Street 2:URB EXT BARINQUEN
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-831-6565
Mailing Address - Fax:787-832-6565
Practice Address - Street 1:CARRETERA 64 KM 37
Practice Address - Street 2:BARIO MANI
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-6565
Practice Address - Fax:787-832-6565
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1971246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
31157Medicare ID - Type Unspecified