Provider Demographics
NPI:1518941749
Name:PEDROSA, DORA ISELLA (MD)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:ISELLA
Last Name:PEDROSA
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 8207
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8207
Mailing Address - Country:US
Mailing Address - Phone:787-778-2210
Mailing Address - Fax:787-778-2215
Practice Address - Street 1:CALLE PALMER 36 ESQUINA ROSSY
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-778-2210
Practice Address - Fax:787-778-2215
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11646207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88666Medicaid
PR88666Medicaid
PRG4130Medicare UPIN