Provider Demographics
NPI:1619087004
Name:ROMERO PEREZ, JESUS A (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:A
Last Name:ROMERO 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:PO BOX 6468
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6468
Mailing Address - Country:US
Mailing Address - Phone:787-832-3630
Mailing Address - Fax:787-832-3515
Practice Address - Street 1:5 CALLE PABLO MAIZ
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4840
Practice Address - Country:US
Practice Address - Phone:787-832-3630
Practice Address - Fax:787-832-3530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG57831Medicare UPIN
PR88555Medicare ID - Type Unspecified