Healthcare Provider Details

I. General information

NPI: 1720058159
Provider Name (Legal Business Name): CARLOS A PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 199 KM. 17.7 3RD FLOOR PEDIATRIX MEDICAL GROUP
GUAYNABO PR
00969
US

IV. Provider business mailing address

D5 CALLE SUNVALLEY GARDEN HILLS
GUAYNABO PR
00966-2613
US

V. Phone/Fax

Practice location:
  • Phone: 866-966-6396
  • Fax:
Mailing address:
  • Phone: 305-494-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number007462
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: