Provider Demographics
NPI:1609951227
Name:PEREZ, NESTOR AMAURY (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:AMAURY
Last Name:PEREZ
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 1:57 CALLE PROF ISABEL C PEREZ
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-4438
Mailing Address - Country:US
Mailing Address - Phone:787-855-6425
Mailing Address - Fax:787-855-0973
Practice Address - Street 1:57 CALLE PROF ISABEL C PEREZ
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4438
Practice Address - Country:US
Practice Address - Phone:787-855-6425
Practice Address - Fax:787-855-0973
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7606208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29828Medicare ID - Type Unspecified
PRC82669Medicare UPIN