Provider Demographics
NPI:1750341566
Name:PEREZ CHIESA, JANET (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:PEREZ CHIESA
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 1:220 WESTERN AUTO PLAZA
Mailing Address - Street 2:STE 101 PMB 381
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3607
Mailing Address - Country:US
Mailing Address - Phone:787-761-2305
Mailing Address - Fax:787-761-1895
Practice Address - Street 1:EDIFICIO CENTRO 4
Practice Address - Street 2:STE 202 CARRETERA 848, KM.0.0
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3607
Practice Address - Country:US
Practice Address - Phone:787-761-2305
Practice Address - Fax:787-761-1895
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5693207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF61232Medicare UPIN