Provider Demographics
NPI:1558989772
Name:PEREZ TIJERINA, LUIS ANDRES (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANDRES
Last Name:PEREZ TIJERINA
Suffix:
Gender:M
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 1942
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1942
Mailing Address - Country:US
Mailing Address - Phone:787-458-6449
Mailing Address - Fax:
Practice Address - Street 1:CALLE HOSTOS #47 ESQ BRAU EL CIBAO
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-0000
Practice Address - Country:US
Practice Address - Phone:787-255-0200
Practice Address - Fax:787-255-0206
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021859208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice