Provider Demographics
NPI:1265681050
Name:CALISTO-PEREZ, CARLOS ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:CALISTO-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 1:832 CALLE CARMEN SANABRIA
Mailing Address - Street 2:VILLA PRADES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2142
Mailing Address - Country:US
Mailing Address - Phone:787-642-2622
Mailing Address - Fax:
Practice Address - Street 1:832 CALLE CARMEN SANABRIA
Practice Address - Street 2:VILLA PRADES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-2142
Practice Address - Country:US
Practice Address - Phone:787-642-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR018430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine