Provider Demographics
NPI:1639626831
Name:PEREZ VIERA, MARUXA (MD)
Entity Type:Individual
Prefix:
First Name:MARUXA
Middle Name:
Last Name:PEREZ VIERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 CALLE ENSUENO
Mailing Address - Street 2:BUENA VISTA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2603
Mailing Address - Country:US
Mailing Address - Phone:651-373-6916
Mailing Address - Fax:
Practice Address - Street 1:1074 CALLE ENSUENO
Practice Address - Street 2:BUENA VISTA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2603
Practice Address - Country:US
Practice Address - Phone:651-373-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19406208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice