Provider Demographics
NPI:1558399865
Name:PEREZ-GUADALUPE, MARISOL (MD)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:PEREZ-GUADALUPE
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 1:1375 CALLE BONITA
Mailing Address - Street 2:URB. MERCEDITA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2610
Mailing Address - Country:US
Mailing Address - Phone:787-449-6050
Mailing Address - Fax:787-813-1334
Practice Address - Street 1:303 PASEO DEL PRINCIPE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2852
Practice Address - Country:US
Practice Address - Phone:787-449-6050
Practice Address - Fax:787-813-1334
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-9781PEMedicare ID - Type Unspecified