Healthcare Provider Details

I. General information

NPI: 1164282729
Provider Name (Legal Business Name): ILEANMARIE PEREZ ALBINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 07/01/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD # 2 KM 173.4 BO CAIN BAJO
SAN GERMAN PR
00683
US

IV. Provider business mailing address

60 CALLE MCKINLEY W UNIT 842
MAYAGUEZ PR
00681-5032
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-1860
  • Fax:
Mailing address:
  • Phone: 787-439-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001834
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24502
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number8694
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: