Provider Demographics
NPI:1538200464
Name:CEBALLOS-VENTURA, PEDRO A (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:CEBALLOS-VENTURA
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 50142
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950
Mailing Address - Country:US
Mailing Address - Phone:787-797-5365
Mailing Address - Fax:787-200-4352
Practice Address - Street 1:CALLE 43 BLOQUE 34 # 1
Practice Address - Street 2:MIRAFLORES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-797-5365
Practice Address - Fax:787-200-4352
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4520208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79619Medicare UPIN