Provider Demographics
NPI:1598929531
Name:PEREZ, MARYLIN
Entity Type:Individual
Prefix:
First Name:MARYLIN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TURABO GARDENS
Mailing Address - Street 2:CALLE1 A8
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-258-6026
Mailing Address - Fax:787-258-6026
Practice Address - Street 1:1 TURABO GARDENS STREET
Practice Address - Street 2:A8
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-6002
Practice Address - Country:US
Practice Address - Phone:787-258-6026
Practice Address - Fax:787-258-6026
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist