Provider Demographics
NPI:1023159720
Name:PEREZ, BLANCA (DO)
Entity type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CALLE JUAN C BORBON
Mailing Address - Street 2:PMB 147 SUITE 67
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5374
Mailing Address - Country:US
Mailing Address - Phone:787-287-0353
Mailing Address - Fax:
Practice Address - Street 1:35 CALLE JUAN C BORBON
Practice Address - Street 2:PMB 147 SUITE 67
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5374
Practice Address - Country:US
Practice Address - Phone:787-287-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6606230441OtherMCS OPTOMETRIST
PR100811OtherCRUZ AZUL
PRA436OtherFIRST MEDICAL
PR215917OtherPREFERRED HEALTH
PR9690093OtherHUMANA