Healthcare Provider Details

I. General information

NPI: 1245747344
Provider Name (Legal Business Name): PROF. JORGE E PEREZ-RENTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA EDIF SAN VICENTE SUITE 412
PONCE PR
00717
US

IV. Provider business mailing address

8169 CALLE CONCORDIA EDIF SAN VICENTE SUITE 412
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: