Provider Demographics
NPI:1962552786
Name:FALCON, IVETTE (MD)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IVETTE
Other - Middle Name:
Other - Last Name:FALCON GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:URB. BORINQUEN GARDENS
Mailing Address - Street 2:JASMIN DD-29
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6311
Mailing Address - Country:US
Mailing Address - Phone:787-547-5646
Mailing Address - Fax:
Practice Address - Street 1:414 AVE BARBOSA
Practice Address - Street 2:BAYAMON METHADONE CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4306
Practice Address - Country:US
Practice Address - Phone:787-787-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9320208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice