Provider Demographics
NPI:1750309274
Name:PEREZ, AMARILIS J
Entity Type:Individual
Prefix:
First Name:AMARILIS
Middle Name:J
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:URB. CONDADO MODERNO
Mailing Address - Street 2:CALLE 13 M36
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-286-8465
Mailing Address - Fax:787-447-1491
Practice Address - Street 1:M36 CALLE 13
Practice Address - Street 2:EDIFICIO CONDADO MODERNO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2443
Practice Address - Country:US
Practice Address - Phone:787-258-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG42136Medicare UPIN
PR82897Medicare ID - Type Unspecified