MEDICARE: DR. ELBA ANTOINETTE PEREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	13348	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84345	OTHER	PR	TRIPLE-S, INC
2	500350	OTHER	PR	MMM HEATHCARE
3	9760040	OTHER	PR	HUMANA HEALTH CARE
4	13348	OTHER	PR	STATE LICENSE

General Provider Information

NPI Number	:	1124027859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELBA ANTOINETTE PEREZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 193868
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-3868
Country	:	US
Telephone Number	:	787-748-7120
Fax Number	:	787-748-7105

Provider Business Practice Location Address
First Line	:	EXPRESO TRUJILLO ALTO KM 4.4
Second Line	:	SAN MIGUEL MEDICAL - SUITE 204 PLAZA SAN MIGUEL
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976
Country	:	US
Telephone Number	:	787-748-7120
Fax Number	:	787-748-7105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/13/2025

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Directions to “ DR. ELBA ANTOINETTE PEREZ M.D.” Practice Location

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