Healthcare Provider Details

I. General information

NPI: 1831757350
Provider Name (Legal Business Name): JUAN CRISTIAN PEREZ OLMOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 FAIRFIELD ST STE F
METAIRIE LA
70006-2763
US

IV. Provider business mailing address

PO BOX 600
MAYAGUEZ PR
00681-0600
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-7250
  • Fax:
Mailing address:
  • Phone: 787-652-9200
  • Fax: 787-652-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number342972
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number22074
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: