MEDICARE: MRS. CARMEN ANNA PEREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	10727	PR

General Provider Information

NPI Number	:	1548262215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN ANNA PEREZ M.D.

Provider Business Mailing Address
First Line	:	181 RUTA 474
Second Line	:	BO. GALATEO BAJO
City	:	ISABELA
State	:	PR
Zip	:	00662-3948
Country	:	US
Telephone Number	:	787-872-1887
Fax Number	:	787-872-1887

Provider Business Practice Location Address
First Line	:	CARR. 474 BARRIO GALATEO BAJO
Second Line	:	BUZON 181
City	:	ISABELA
State	:	PR
Zip	:	00662-3948
Country	:	US
Telephone Number	:	787-872-1887
Fax Number	:	787-872-1887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/12/2012

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