Preciado-Riestra, Juan Sebastian

Preciado-Riestra, Juan Sebastian is an individual health care provider with primary practice located at 400 S Townline Rd , Wautoma WI 54982-6922. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Preciado-Riestra, Juan Sebastian can be contacted via phone (920) 787-4737.

Contact Information

Primary practice address
400 S Townline Rd Wautoma WI 54982-6922
Phone: (920) 787-4737
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 46438-020 Wisconsin

Profile Details

NPI number 1295739225
LBN Legal business name Preciado-Riestra, Juan Sebastian
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2005
Last updated Apr 29th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295739225 NPPES
Wisconsin Other 521823 MEDICARE PART A - CLINIC
Wisconsin MEDICAID 34313600 MEDICARE PART A - CLINIC
Wisconsin Other 46438 MEDICARE PART A - CLINIC
Wisconsin Other 521824 MEDICARE PART A - CLINIC

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