Provider Demographics
NPI:1891704755
Name:PEREZ MEDINA, ADRIAN (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:PEREZ MEDINA
Suffix:
Gender:M
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:PASEO DEL CAMPO #8 CARRETERA 492 BO. CORCOBADO
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00659
Mailing Address - Country:UM
Mailing Address - Phone:787-898-3346
Mailing Address - Fax:
Practice Address - Street 1:CORP. SERVICIOS MEDICOS CALLE DR. SUSONI NUM. 121
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13,837208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20802Medicare ID - Type Unspecified
PRH55692Medicare UPIN