Provider Demographics
NPI:1831316215
Name:PEREZ-DORTA, MILDRED (RPH)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:PEREZ-DORTA
Suffix:
Gender:F
Credentials:RPH
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 721
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0721
Mailing Address - Country:US
Mailing Address - Phone:787-399-9712
Mailing Address - Fax:
Practice Address - Street 1:ROAD 129 AND AVE. ROTARIO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-650-7280
Practice Address - Fax:787-650-7302
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist