Provider Demographics
NPI:1831594019
Name:SERVIA PEREZ, KEILA M
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:M
Last Name:SERVIA PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 COND PUERTA DEL PARQUE
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3143
Mailing Address - Country:US
Mailing Address - Phone:787-955-0426
Mailing Address - Fax:
Practice Address - Street 1:1320 AVE SAN ALFONSO
Practice Address - Street 2:URB SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3621
Practice Address - Country:US
Practice Address - Phone:787-782-6403
Practice Address - Fax:787-782-0630
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8951183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician