Provider Demographics
NPI:1407625114
Name:PEREZ PRATS, EMMANUEL JOSE
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:JOSE
Last Name:PEREZ PRATS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AVE LA SIERRA # 177
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4351
Mailing Address - Country:US
Mailing Address - Phone:787-292-2050
Mailing Address - Fax:
Practice Address - Street 1:400 AVE LA SIERRA # 177
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4351
Practice Address - Country:US
Practice Address - Phone:787-292-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR016212183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician