Provider Demographics
NPI:1093901068
Name:PEREZ, OMAR (PHD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PHD
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 60327
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6032
Mailing Address - Country:US
Mailing Address - Phone:787-288-0200
Mailing Address - Fax:787-288-0242
Practice Address - Street 1:AVENIDA LAUREL, ESQUINA POWELL
Practice Address - Street 2:UNIVERSIDAD CENTRAL DEL CARIBE/HOSPITAL RUIZ ARNAU
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-6032
Practice Address - Country:US
Practice Address - Phone:787-288-0200
Practice Address - Fax:787-288-0242
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2201103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist