Provider Demographics
NPI:1326268251
Name:PEREZ PALMER DE JESUS
Entity Type:Organization
Organization Name:PEREZ PALMER DE JESUS
Other - Org Name:CENTRO DE MEDICINA INTEGRADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-746-4610
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0304
Mailing Address - Country:US
Mailing Address - Phone:787-746-4610
Mailing Address - Fax:787-745-4030
Practice Address - Street 1:X2 AVE L MUNOZ MARIN
Practice Address - Street 2:MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6431
Practice Address - Country:US
Practice Address - Phone:787-746-4610
Practice Address - Fax:787-745-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0571261QP2000X
PR9301261QP2300X
PR8868261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE81686Medicare UPIN
PRS32021Medicare UPIN
PRF95025Medicare UPIN