Provider Demographics
NPI:1841210218
Name:PEREZ ROLON, MAGDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAGDA
Middle Name:
Last Name:PEREZ ROLON
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:CALLE 6
Mailing Address - Street 2:ESTANCIAS DE SAN FERNANDO D1
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5216
Mailing Address - Country:US
Mailing Address - Phone:787-869-4721
Mailing Address - Fax:787-869-0536
Practice Address - Street 1:CARRETERA 152 INTERSECCION 803
Practice Address - Street 2:BARRIO CEDRO ARRUBA
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-4721
Practice Address - Fax:787-869-0536
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11068208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011399OtherPREFERRED HEALTH
400287OtherMEDICARE Y MUCHO MAS
04002OtherAMERICAN HEALTH
83314OtherTRIPLE S
7190114OtherHUMANA INSURANCE OF PR
1056OtherINTL MEDICAL CARD
83314OtherMEDICARE OPTIMO
M00366OtherPLAN DE SALUD HOSPITAL
400287OtherMEDICARE Y MUCHO MAS
0083314Medicare ID - Type Unspecified