Provider Demographics
NPI:1710959663
Name:PERELES-RIVERA, YASMIN (-MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:PERELES-RIVERA
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:PO BOX 6643
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5643
Mailing Address - Country:US
Mailing Address - Phone:787-274-1548
Mailing Address - Fax:787-274-1548
Practice Address - Street 1:207 AVE DOMENECH
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3523
Practice Address - Country:US
Practice Address - Phone:787-274-1548
Practice Address - Fax:787-274-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-05
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9732208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF94456Medicare UPIN