Provider Demographics
NPI:1114278090
Name:PEREZ, JEANNETH ALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETH
Middle Name:ALINA
Last Name:PEREZ
Suffix:
Gender:F
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0186
Mailing Address - Country:US
Mailing Address - Phone:787-246-8796
Mailing Address - Fax:
Practice Address - Street 1:STREET 4 MARIA DEL CARMEN H 5
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-0000
Practice Address - Country:US
Practice Address - Phone:787-246-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18521208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18521OtherPR REGULAR LICENSE NUMBER