Provider Demographics
NPI:1033190426
Name:SERPA PEREZ, MIGUEL
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:SERPA PEREZ
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 800389
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0389
Mailing Address - Country:US
Mailing Address - Phone:787-643-6045
Mailing Address - Fax:
Practice Address - Street 1:CENTRO NUCLEAR
Practice Address - Street 2:SAN CRISTOBAL
Practice Address - City:COTTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-0389
Practice Address - Country:US
Practice Address - Phone:787-848-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11786207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088863Medicare ID - Type UnspecifiedPROVIDER NUMBER