MEDICARE: MS. CARMEN MARIA PEREZ RD

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	133V00000X	Registered Dietitian	945	PR
2	133V00000X	Registered Dietitian	10150	PR

General Provider Information

NPI Number	:	1740530005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARMEN MARIA PEREZ RD

Provider Business Mailing Address
First Line	:	COND. VISTA VERDE
Second Line	:	#1200 ROAD 849 APT. F-231
City	:	SAN JUAN
State	:	PR
Zip	:	00924
Country	:	US
Telephone Number	:	787-216-7939
Fax Number	:

Provider Business Practice Location Address
First Line	:	VISTA VERDE
Second Line	:	#1200 ROAD 849 APT. F-231
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4563
Country	:	US
Telephone Number	:	787-216-7939
Fax Number	:

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

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	09/14/2012

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