Healthcare Provider Details

I. General information

NPI: 1760565543
Provider Name (Legal Business Name): JORGE J. PEREZ BRAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. DOMENECH 390
HATO REY PR
00918
US

IV. Provider business mailing address

AVE. DOMENECH 390
HATO REY PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-7328
  • Fax: 787-753-4513
Mailing address:
  • Phone: 787-764-7328
  • Fax: 787-753-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7292
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: