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NPI Code Detail

MEDICARE: MRS. CORAL MARIE PEREZ GONZALEZ

MEDICARE: MRS. CORAL MARIE PEREZ GONZALEZ
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1588334486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CORAL MARIE PEREZ GONZALEZ
Provider Business Mailing Address
First Line : PO BOX 533
Second Line :
City : MOCA
State : PR
Zip : 00676-0533
Country : US
Telephone Number : 939-245-1696
Fax Number :
Provider Business Practice Location Address
First Line : 997 CALLE SAN ROBERTO
Second Line :
City : SAN JUAN
State : PR
Zip : 00926-2759
Country : US
Telephone Number : 939-245-1696
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2021
Last Update Date : 09/14/2021

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