Healthcare Provider Details

I. General information

NPI: 1972745297
Provider Name (Legal Business Name): ANGEL LUIS PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 AVE BARBOSA
ARECIBO PR
00612-4329
US

IV. Provider business mailing address

53 AVE BARBOSA
ARECIBO PR
00612-4329
US

V. Phone/Fax

Practice location:
  • Phone: 787-690-7953
  • Fax: 787-680-7848
Mailing address:
  • Phone: 787-815-1440
  • Fax: 787-815-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18162
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: