Healthcare Provider Details

I. General information

NPI: 1811010663
Provider Name (Legal Business Name): MR. LUIS A PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 5 BOX 8537
BAYAMON PR
00956-9757
US

IV. Provider business mailing address

FLAMBOYAN 237
TOA BAJA PR
00951
US

V. Phone/Fax

Practice location:
  • Phone: 787-797-8335
  • Fax:
Mailing address:
  • Phone: 407-452-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number4283
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: