Provider Demographics
NPI:1164525002
Name:PEREZ, LUIS T (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:T
Last Name:PEREZ
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:PLAZA 15 BF 25
Mailing Address - Street 2:BOSQUE DEL LAGO-ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6051
Mailing Address - Country:US
Mailing Address - Phone:787-755-7855
Mailing Address - Fax:
Practice Address - Street 1:BF25 PLAZA 15
Practice Address - Street 2:BOSQUE DEL LAGO-ENCANTADA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6051
Practice Address - Country:US
Practice Address - Phone:787-755-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE90883Medicare UPIN
PR82508Medicare ID - Type Unspecified