Healthcare Provider Details

I. General information

NPI: 1265652093
Provider Name (Legal Business Name): SERGIO A. PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E11 CALLE LAUREL COLINAS DE GUAYNABO
GUAYNABO PR
00969-6209
US

IV. Provider business mailing address

PO BOX 6137
CAGUAS PR
00726-6137
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-2525
  • Fax:
Mailing address:
  • Phone: 787-272-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4715
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: