Healthcare Provider Details

I. General information

NPI: 1982694766
Provider Name (Legal Business Name): LOURDES R PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CONCORDIA #8118 GALENA PROFESIONAL SUITE 105
PONCE PR
00717-1589
US

IV. Provider business mailing address

CALLE CONCORDIA #8118 GALENA PROFESIONAL SUITE 105
PONCE PR
00717-1589
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-3067
  • Fax:
Mailing address:
  • Phone: 787-844-3067
  • Fax: 787-844-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9932
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: