Provider Demographics
NPI:1831120286
Name:PEREZ, NYDIA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:L
Last Name:PEREZ
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:MALAGUETA ST. #111
Mailing Address - Street 2:URB. CIUDAD JARDIN DE GURABO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-737-1764
Mailing Address - Fax:
Practice Address - Street 1:111 CALLE MALAGUETA
Practice Address - Street 2:URB. CIUDAD JARDIN DE GURABO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-9660
Practice Address - Country:US
Practice Address - Phone:787-737-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine