Provider Demographics
NPI:1649280090
Name:PEREZ FERNANDEZ, CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:PEREZ FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:PEREZ FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:MK6 PLAZA 44
Mailing Address - Street 2:URB. MONTE CLARO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-4787
Mailing Address - Country:US
Mailing Address - Phone:787-649-9837
Mailing Address - Fax:787-780-7168
Practice Address - Street 1:MK6 PLAZA 44
Practice Address - Street 2:URB. MONTE CLARO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4787
Practice Address - Country:US
Practice Address - Phone:787-649-9837
Practice Address - Fax:787-780-7168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12327177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging