Provider Demographics
NPI:1396764056
Name:PEREZ, MARIA L (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70011
Mailing Address - Street 2:PMB 67
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-7011
Mailing Address - Country:US
Mailing Address - Phone:787-860-4466
Mailing Address - Fax:787-860-4466
Practice Address - Street 1:52 CALLE CELIS AGUILERA N
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4811
Practice Address - Country:US
Practice Address - Phone:787-860-4466
Practice Address - Fax:787-860-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16028171100000X, 207PE0004X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-49006Medicare UPIN