Healthcare Provider Details

I. General information

NPI: 1174013551
Provider Name (Legal Business Name): CENTRO MEDICO PEREZ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10324 ROOSEVELT AVE STE 306
CORONA NY
11368-1562
US

IV. Provider business mailing address

10324 ROOSEVELT AVE STE 306
CORONA NY
11368-1562
US

V. Phone/Fax

Practice location:
  • Phone: 347-201-4567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SALVADOR PEREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 347-201-4567