Healthcare Provider Details

I. General information

NPI: 1033188628
Provider Name (Legal Business Name): ELLIOT E PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DE INFANTERIA #23B
LAJAS PR
00660
US

IV. Provider business mailing address

ESTANCIAS DEL RIO CALLE PORTUGUES 506
HORMIGUEROS PR
00660
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-4110
  • Fax: 787-899-4110
Mailing address:
  • Phone: 787-899-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number13971
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: