Provider Demographics
NPI:1558315960
Name:BREA PEREZ, MAYRA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:E
Last Name:BREA PEREZ
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:PO BOX 8731
Mailing Address - Street 2:PLAZA CAROLINA STA.
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8731
Mailing Address - Country:US
Mailing Address - Phone:787-761-4915
Mailing Address - Fax:
Practice Address - Street 1:L2 CALLE 6
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-2825
Practice Address - Country:US
Practice Address - Phone:787-888-8886
Practice Address - Fax:787-888-8887
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR884475Medicare ID - Type Unspecified
PRG-37215Medicare UPIN