MEDICARE: DR. NICOLAS M PEREZ MALDONADO 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	2084N0400X	Neurology Physician	10813	PR

General Provider Information

NPI Number	:	1558354829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS M PEREZ MALDONADO M.D.

Provider Business Mailing Address
First Line	:	68 CALLE SANTA CRUZ
Second Line	:	EDIF TORRE SAN PABLO SUITE 401
City	:	BAYAMON
State	:	PR
Zip	:	00961-7031
Country	:	US
Telephone Number	:	787-785-2424
Fax Number	:	787-785-2425

Provider Business Practice Location Address
First Line	:	68 CALLE SANTA CRUZ
Second Line	:	EDIF TORRE SAN PABLO SUITE 401
City	:	BAYAMON
State	:	PR
Zip	:	00961-7031
Country	:	US
Telephone Number	:	787-785-2424
Fax Number	:	787-785-2425

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	01/18/2013

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