Provider Demographics
NPI:1295859783
Name:PEREZ DIAZ, ROBINDRANATH (MT)
Entity Type:Individual
Prefix:
First Name:ROBINDRANATH
Middle Name:
Last Name:PEREZ DIAZ
Suffix:
Gender:M
Credentials:MT
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 140267
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0267
Mailing Address - Country:US
Mailing Address - Phone:787-820-5371
Mailing Address - Fax:787-820-5371
Practice Address - Street 1:130 RD K.M. 11.6 CAMPO ALEGRE WD
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-5371
Practice Address - Fax:787-820-5371
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR701291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030066Medicare PIN