Provider Demographics
NPI:1043990716
Name:PEREZ NAVEIRA, CARLOS ISMAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ISMAEL
Last Name:PEREZ NAVEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 13493
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9364
Mailing Address - Country:US
Mailing Address - Phone:787-599-2660
Mailing Address - Fax:
Practice Address - Street 1:2435 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2112
Practice Address - Country:US
Practice Address - Phone:787-599-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23467208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice