Healthcare Provider Details

I. General information

NPI: 1477769750
Provider Name (Legal Business Name): LUIS R. PEREZ LAGUILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA CORAZONES 1040
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 1558
MAYAGUEZ PR
00681-1558
US

V. Phone/Fax

Practice location:
  • Phone: 787-226-0480
  • Fax:
Mailing address:
  • Phone: 787-226-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number11640
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: