Provider Demographics
NPI:1205837564
Name:HERMIDA PEREZ, GIL ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:ANGEL
Last Name:HERMIDA 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 1:2007 CALLE EXTREMADURA
Mailing Address - Street 2:URB LA RAMBLA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4079
Mailing Address - Country:US
Mailing Address - Phone:787-842-7683
Mailing Address - Fax:
Practice Address - Street 1:8169 CALLE CONCORDIA, OF. 309
Practice Address - Street 2:COND. SAN VICENTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1563
Practice Address - Country:US
Practice Address - Phone:787-843-8554
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89793Medicare ID - Type Unspecified
PRG79075Medicare UPIN