Healthcare Provider Details

I. General information

NPI: 1336099548
Provider Name (Legal Business Name): JUAN PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 ZONA IND REPARADA 2
PONCE PR
00716-2347
US

IV. Provider business mailing address

33 CALLE PALACIOS URB. LAS MANSIONES DE SAN MARTIN
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-207-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: