Healthcare Provider Details

I. General information

NPI: 1487815668
Provider Name (Legal Business Name): THELMA ALEJANDRO PEREZ TO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA CAROLINA ROBERTO CLEMENTE AVE BLK 27-16
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 2963
CAROLINA PR
00984-2963
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax:
Mailing address:
  • Phone: 787-276-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number976
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: