Provider Demographics
NPI:1528388683
Name:PERPAR PSC
Entity Type:Organization
Organization Name:PERPAR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-522-0836
Mailing Address - Street 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:INSTITUTO SAN PABLO SUITE 304
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7041
Mailing Address - Country:US
Mailing Address - Phone:787-522-0836
Mailing Address - Fax:787-522-0837
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO # 304
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-522-0836
Practice Address - Fax:787-522-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10324261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF28743Medicare UPIN