Healthcare Provider Details

I. General information

NPI: 1326268251
Provider Name (Legal Business Name): PEREZ PALMER DE JESUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

X2 AVE L MUNOZ MARIN MARIOLGA
CAGUAS PR
00725-6431
US

IV. Provider business mailing address

PO BOX 304
GUAYNABO PR
00970-0304
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-4610
  • Fax: 787-745-4030
Mailing address:
  • Phone: 787-746-4610
  • Fax: 787-745-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0571
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number9301
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number8868
License Number StatePR

VIII. Authorized Official

Name: DR. ANGEL D PEREZ
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-746-4610