Provider Demographics
NPI:1407826100
Name:CLIMENT-PERIS, CONSUELO (MD)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:CLIMENT-PERIS
Suffix:
Gender:F
Credentials:MD
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 365067
Mailing Address - Street 2:DEPT. PATOLOGIA RCM
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-766-3150
Mailing Address - Fax:787-754-0710
Practice Address - Street 1:PATOLOGIA RCM
Practice Address - Street 2:APARTADO 29134
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929-0134
Practice Address - Country:US
Practice Address - Phone:787-766-3150
Practice Address - Fax:787-754-0710
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5592207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-3830Medicare PIN