Provider Demographics
NPI:1518061969
Name:PEREZ COLON, LIANETTE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LIANETTE
Middle Name:M
Last Name:PEREZ COLON
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 1:100 GRAN BULEVAR PASEOS
Mailing Address - Street 2:SUITE 112 MSC 457
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-258-0614
Mailing Address - Fax:787-961-4663
Practice Address - Street 1:500 AVE DEGETAU
Practice Address - Street 2:HIMA PLAZA SUITE 414
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-258-0614
Practice Address - Fax:787-961-4663
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020321OtherPTAN
H82238Medicare UPIN