Provider Demographics
NPI:1750350864
Name:PEREZ SEMIDEI, CARLOS E (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:E
Last Name:PEREZ SEMIDEI
Suffix:
Gender:M
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:PMB 325 PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00951
Mailing Address - Country:UM
Mailing Address - Phone:787-870-6893
Mailing Address - Fax:787-870-6893
Practice Address - Street 1:CALLE 1 VILLA AMPARO
Practice Address - Street 2:15-B BO CONTORNO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-6893
Practice Address - Fax:787-870-6893
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11183208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREL111AOtherPTAN
PREL111AOtherPTAN