Provider Demographics
NPI:1205185451
Name:PEREZ, JESUS MANUEL
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MANUEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PBOX 1322
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-922-1544
Mailing Address - Fax:
Practice Address - Street 1:365 CALLE FLOR DE SIERRA
Practice Address - Street 2:URB HACIENDA REAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-9781
Practice Address - Country:US
Practice Address - Phone:787-922-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5826183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5826OtherPHARMACY TECHNICIAN LICENSE