Provider Demographics
NPI:1992714133
Name:PAEZ GONZALEZ, PEDRO P (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:P
Last Name:PAEZ GONZALEZ
Suffix:
Gender:M
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:P.O. BOX 190464
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00919 0464
Mailing Address - Country:UM
Mailing Address - Phone:787-725-8534
Mailing Address - Fax:
Practice Address - Street 1:ASHFORD MEDICAL CENTER #29 CALLE WASHINGTON
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00907 1503
Practice Address - Country:UM
Practice Address - Phone:787-725-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8815207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88060OtherTRIPLE S PUERTO RICO
PRE43400Medicare UPIN
PR88060OtherTRIPLE S PUERTO RICO
E43400Medicare UPIN
0029866Medicare PIN