Provider Demographics
NPI:1568793214
Name:DROS- PEREZ, JACQUELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:DROS- PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:DROS - PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:HC 1 BOX 3167
Mailing Address - Street 2:CARR 4453 KM 0.2
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9602
Mailing Address - Country:US
Mailing Address - Phone:787-221-7512
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 3167
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-9602
Practice Address - Country:US
Practice Address - Phone:787-221-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17727208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice