Healthcare Provider Details

I. General information

NPI: 1063170819
Provider Name (Legal Business Name): JOSE JUAN HERMINA PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date: 04/14/2022
Reactivation Date: 06/01/2022

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2696
US

V. Phone/Fax

Practice location:
  • Phone: 787-642-9168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1027619
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: