Provider Demographics
NPI:1821218579
Name:PEREZ, GLORIVI (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIVI
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DMD
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 20281
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0281
Mailing Address - Country:US
Mailing Address - Phone:787-765-7915
Mailing Address - Fax:787-767-5287
Practice Address - Street 1:124 CALLE ARZUAGA
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3302
Practice Address - Country:US
Practice Address - Phone:787-765-7915
Practice Address - Fax:787-767-5287
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice