Provider Demographics
NPI:1407076748
Name:PEREZ, MIRSONIA L (PH)
Entity Type:Individual
Prefix:
First Name:MIRSONIA
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUND HILL
Mailing Address - Street 2:1639 DALIA ST.
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2734
Mailing Address - Country:US
Mailing Address - Phone:787-755-6640
Mailing Address - Fax:
Practice Address - Street 1:ROUND HILL
Practice Address - Street 2:1639 DALIA ST.
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2734
Practice Address - Country:US
Practice Address - Phone:787-755-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist