Provider Demographics
NPI:1689437808
Name:PEREZ, ERIC JOSE
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOSE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
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 70
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-0070
Mailing Address - Country:US
Mailing Address - Phone:787-398-4549
Mailing Address - Fax:
Practice Address - Street 1:ST. 459 KM. 11.9 INT. BO. JOBOS
Practice Address - Street 2:ISABELA, P.R. 00662
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0066
Practice Address - Country:US
Practice Address - Phone:787-398-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program