Provider Demographics
NPI:1053920967
Name:CANUELAS ECHEVARRIA, PEDRO ALEJANDRO
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ALEJANDRO
Last Name:CANUELAS ECHEVARRIA
Suffix:
Gender:M
Credentials:
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 224
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0224
Mailing Address - Country:US
Mailing Address - Phone:787-836-7446
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA 913B
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23075207R00000X
PR34911R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine