Raquel Ita Berezdivin, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

845PA Issued in PR

Practice address

1511 Avenida de la Constitucion
Suite 3
San Juan, PR 00909

Phone

(787) 339-2639

NPI assigned

Apr 11, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Raquel Ita Franco Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1114669140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 CALLE CALISTEMON",
            "city": "GUAYNABO",
            "state": "PR",
            "postal_code": "009663166",
            "telephone_number": "786-223-7624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 AVENIDA DE LA CONSTITUCION",
            "address_2": "SUITE 3",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00909",
            "telephone_number": "787-339-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEREZDIVIN",
        "first_name": "RAQUEL",
        "middle_name": "ITA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-10-28",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113995",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PR",
            "license": "845PA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "pravanhealth.slack.com",
            "affiliation": "Y",
            "affiliationName": "Pravan Wellness, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1511 Avenida de la Constitucion",
            "address_2": "Suite 3",
            "city": "San Juan",
            "state": "PR",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "RAQUEL",
            "last_name": "FRANCO",
            "middle_name": "ITA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bepresent LLC
• Pedro Federico Berdeguer-de Leon, M.D.
• Otto Agustin Berdiel, MS
• Roberto Berdiel, D.M.D.
• Michael Beretta
• Jadailine Bermudez Santos
• Ramon H Bermudez-del Valle, MD
• Lorianne Bermudez-Rivera
• Abdiel Bermudez
• Ana L Bermudez, MD

• Physician Assistant in San Juan, PR
• Providers in San Juan, PR by specialty
• Physician Assistant in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.