Provider Demographics
NPI:1679694731
Name:PEREZ, CARMEN
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE NICOLAS AGUAYO NUM 1221
Mailing Address - Street 2:URB EL COMANDANTE
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-768-8262
Mailing Address - Fax:
Practice Address - Street 1:1221 CALLE NICOLAS AGUAYO
Practice Address - Street 2:URB EL COMANDANTE
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924-3657
Practice Address - Country:US
Practice Address - Phone:787-768-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12390208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics