=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295191971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSA I PEREZ TORRES, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2016
-----------------------------------------------------
Last Update Date | 01/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 CALLE BASILIO CATALA 710 COND PRADOS DEL MONTE
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00971-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-292-9861
-----------------------------------------------------
Fax | 787-292-9861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 CALLE BASILIO CATALA 710 COND PRADOS DEL MONTE
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00971-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-292-9861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDITARICIAN
-----------------------------------------------------
Name | DR. ROSA I PEREZ TORRES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-292-8615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | 7663
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 7663
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------