Provider Demographics
NPI:1518267087
Name:PEREZ, MARISOL (RN)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A-3 AVENIDA PEREZ ANDINO
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-5113
Mailing Address - Country:US
Mailing Address - Phone:787-888-2302
Mailing Address - Fax:787-888-2302
Practice Address - Street 1:F-20 CALLE CLEVELAND PARKVILLE
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4418
Practice Address - Country:US
Practice Address - Phone:787-888-2302
Practice Address - Fax:787-888-2302
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32479163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice