Provider Demographics
NPI:1932264819
Name:PEREZ, SARA ISMARI (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ISMARI
Last Name:PEREZ
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 1:200 AVE WINSTON CHURCHILL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6651
Mailing Address - Country:US
Mailing Address - Phone:787-772-8384
Mailing Address - Fax:787-765-7864
Practice Address - Street 1:200 AVE WINSTON CHURCHILL
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6651
Practice Address - Country:US
Practice Address - Phone:787-772-8384
Practice Address - Fax:787-765-7864
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13058207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82904Medicare UPIN
PR0090133Medicare ID - Type Unspecified