Healthcare Provider Details

I. General information

NPI: 1114107109
Provider Name (Legal Business Name): VICTOR M PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 ARCHBISHOP FLORES ST SUITE 403C
HAGATNA GU
96910-5206
US

IV. Provider business mailing address

114 ETTON CT SUITE 403C
SINAJANA GU
96910-3224
US

V. Phone/Fax

Practice location:
  • Phone: 671-477-4619
  • Fax: 671-477-4619
Mailing address:
  • Phone: 671-988-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM000893
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM893
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: