Provider Demographics
NPI:1528208337
Name:PEREZ PEDROGO, CORALEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORALEE
Middle Name:
Last Name:PEREZ PEDROGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA NEVAREZ STREET 10
Mailing Address - Street 2:1020
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-0152
Mailing Address - Country:US
Mailing Address - Phone:787-299-4792
Mailing Address - Fax:787-751-0772
Practice Address - Street 1:CONDADO STREET NUMBER 607
Practice Address - Street 2:COND. CONDADO OFFICE 401
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-299-4792
Practice Address - Fax:787-725-5013
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical