Provider Demographics
NPI:1538136783
Name:PEREZ VIZCARRONDO, CARLOS RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RUBEN
Last Name:PEREZ VIZCARRONDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:URB MONTE SOL A1 CALLE 4
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-765-4799
Mailing Address - Fax:787-765-4799
Practice Address - Street 1:AVE. LUIS MUNOZ RIVERA 1007
Practice Address - Street 2:EDIF DARLINGTON SUITE 307
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-765-4799
Practice Address - Fax:787-765-4799
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2010-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR10405208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF47559Medicare UPIN
PR0082829Medicare ID - Type Unspecified