Provider Demographics
NPI:1629161682
Name:DONATE-PEREZ, DORA DE LOURDES (MD,)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:DE LOURDES
Last Name:DONATE-PEREZ
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AVE JESUS T PINERO APT 901
Mailing Address - Street 2:PARQUE DE LOYOLA NORTH COND.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4064
Mailing Address - Country:US
Mailing Address - Phone:787-757-1800
Mailing Address - Fax:787-701-4490
Practice Address - Street 1:65TH INFANTRY AVE
Practice Address - Street 2:UPR HOSPITAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:787-701-4490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10697207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR641004Medicare UPIN