Provider Demographics
NPI:1972745297
Name:PEREZ, ANGEL LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:PEREZ
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 1:53 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4329
Mailing Address - Country:US
Mailing Address - Phone:787-815-1440
Mailing Address - Fax:787-815-7953
Practice Address - Street 1:53 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4329
Practice Address - Country:US
Practice Address - Phone:787-690-7953
Practice Address - Fax:787-680-7848
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics