Provider Demographics
NPI:1609838556
Name:PEREZ MORENO, JOSHARA M (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHARA
Middle Name:M
Last Name:PEREZ MORENO
Suffix:
Gender:F
Credentials:OD
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 623
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:# 38 MUNOZ RIVERA
Practice Address - Street 2:ESQ RIUS RIVERA
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-9285
Practice Address - Fax:787-851-9285
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82882Medicare UPIN