Provider Demographics
NPI:1548533128
Name:DR. PEDRO P. PAEZ GONZALEZ P.C.S.
Entity type:Organization
Organization Name:DR. PEDRO P. PAEZ GONZALEZ P.C.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAEZ-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-725-8534
Mailing Address - Street 1:PO BOX 190464
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0464
Mailing Address - Country:US
Mailing Address - Phone:787-725-8534
Mailing Address - Fax:787-724-0200
Practice Address - Street 1:ASHFORD MEDICAL CTR
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-725-8534
Practice Address - Fax:787-724-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty