Provider Demographics
NPI:1053182766
Name:PEGUERO, JOSE MIGUEL JR (LPN)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MIGUEL
Last Name:PEGUERO
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 MACK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5623
Mailing Address - Country:US
Mailing Address - Phone:610-898-3802
Mailing Address - Fax:
Practice Address - Street 1:1542 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-5968
Practice Address - Country:US
Practice Address - Phone:484-330-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver