Provider Demographics
NPI:1326103292
Name:PEREZ RODRIGUEZ, JESUS ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ANTONIO
Last Name:PEREZ RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:SUITE 102 PMB 451
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-837-4122
Mailing Address - Fax:787-837-4122
Practice Address - Street 1:49 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2205
Practice Address - Country:US
Practice Address - Phone:787-847-0457
Practice Address - Fax:787-847-0457
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1206OtherAMERICAN HEALTH, INC.
PR3710874OtherUIA
PR1662OtherFIRST MEDICAL
PR060943OtherLA CRUZ AZUL
PR209286OtherUTI
PRPE3577OtherPALIC
PR41055023OtherPROSSAM
PR7310254OtherHUMANA
PR89146PEOtherTRIPLE S,INC
PR3710874OtherUIA
PR060943OtherLA CRUZ AZUL
PR1662OtherFIRST MEDICAL