Healthcare Provider Details

I. General information

NPI: 1659364644
Provider Name (Legal Business Name): RAFAEL PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL SAN JUAN CENTRO MEDICO
SAN JUAN PR
00936
US

IV. Provider business mailing address

PASEO LOS CORALES 547 MAR CARIBE
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-2223
  • Fax:
Mailing address:
  • Phone: 787-667-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13501
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: