Healthcare Provider Details

I. General information

NPI: 1760681647
Provider Name (Legal Business Name): JESSICA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR.155 DESVIO
OROCOVIS PR
00720
US

IV. Provider business mailing address

HC-03 BOX 14925 BO.MANA SECTOR PARADOR
COROZAL PR
00783
US

V. Phone/Fax

Practice location:
  • Phone: 787-867-6010
  • Fax: 787-867-6008
Mailing address:
  • Phone: 787-859-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3493
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: