Provider Demographics
NPI:1245250471
Name:PEREZ, JACQUELINE ESMERALDINA (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ESMERALDINA
Last Name:PEREZ
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 1:1652 CALLE SANTA AGUEDA
Mailing Address - Street 2:C-8 LES CHALETS COURT
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4135
Mailing Address - Country:US
Mailing Address - Phone:787-550-0647
Mailing Address - Fax:787-753-5365
Practice Address - Street 1:U-3-3,CARR21,LAS LOMAS
Practice Address - Street 2:SUITE-1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-3580
Practice Address - Fax:787-781-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12150208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20153Medicare ID - Type Unspecified
PRI49585Medicare UPIN