Provider Demographics
NPI:1295991032
Name:PEREZ, MIRIAM (LCDA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7351 AVE AGUSTIN RAMOS CALERO
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-5206
Mailing Address - Country:US
Mailing Address - Phone:787-450-2343
Mailing Address - Fax:787-830-7605
Practice Address - Street 1:HC 7 BOX 35436
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-9433
Practice Address - Country:US
Practice Address - Phone:787-450-2343
Practice Address - Fax:787-830-7605
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5027291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory