Provider Demographics
NPI:1558578625
Name:PEREZ-CORTES, CARLOS O
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:O
Last Name:PEREZ-CORTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. FONT MARTELO # 355
Mailing Address - Street 2:HOSPITAL RYDER OFFICE 403
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-2415
Mailing Address - Fax:787-850-0471
Practice Address - Street 1:AVE. FONT MARTELO # 355
Practice Address - Street 2:HOSPITAL RYDER OFFICE 403
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-2415
Practice Address - Fax:787-850-0471
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR89352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-2608Medicare ID - Type UnspecifiedNON-PROVIDER NUMBER