Healthcare Provider Details

I. General information

NPI: 1588053821
Provider Name (Legal Business Name): JOSE G PEREZ M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 852 KM 6.4 BO QUEBRADA GRANDE SECTOR SABANA
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

HC 645 BOX 6352
TRUJILLO ALTO PR
00976-9749
US

V. Phone/Fax

Practice location:
  • Phone: 787-458-0543
  • Fax:
Mailing address:
  • Phone: 787-458-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3798
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: