Provider Demographics
NPI:1073575833
Name:PEREZ MORENO, GILDA B (MD)
Entity Type:Individual
Prefix:DR
First Name:GILDA
Middle Name:B
Last Name:PEREZ MORENO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:74 CALLE VENUS
Mailing Address - Street 2:PISO 2 URB. ATLANTIC VIEW
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4805
Mailing Address - Country:US
Mailing Address - Phone:787-649-9348
Mailing Address - Fax:787-268-7237
Practice Address - Street 1:RR 1 CALLE 12
Practice Address - Street 2:SUITE 3 BARRIO CANA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6245
Practice Address - Country:US
Practice Address - Phone:787-649-9348
Practice Address - Fax:787-268-7237
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR15583208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022705Medicare ID - Type Unspecified