Provider Demographics
NPI:1205914108
Name:PEREZ, IRIS ICELA
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:ICELA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB EL VALLE 179
Mailing Address - Street 2:CALLE BUCAYO GIGANTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URB EL VALLE 179
Practice Address - Street 2:CALLE BUCAYO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3213
Practice Address - Country:US
Practice Address - Phone:939-717-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR72602216OtherHUMANA