Healthcare Provider Details

I. General information

NPI: 1699033720
Provider Name (Legal Business Name): HECTOR E PEREZ MEDICAL TECHNOLOGYST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD #3 KM. 49.7 MONTE SOL SHOPPING CENTER SUITE 106
FAJARDO PR
00738
US

IV. Provider business mailing address

572 CALLE FERRARA VILLA CAPRI
SAN JUAN PR
00924-4047
US

V. Phone/Fax

Practice location:
  • Phone: 787-801-8181
  • Fax: 787-801-8181
Mailing address:
  • Phone: 787-293-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number2018
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: