Provider Demographics
NPI:1396319752
Name:ISLAND PERINATAL, LLC
Entity type:Organization
Organization Name:ISLAND PERINATAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:PEREZ YORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-486-0529
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL STE 812
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-486-0529
Mailing Address - Fax:
Practice Address - Street 1:CARR. 172 CAGUAS A CIDRA, URB TURABO GARDENS
Practice Address - Street 2:SUITE 108
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-486-0529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty