MEDICARE: DR. LUIS G. PEREZ 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	2085R0202X	Diagnostic Radiology Physician	21094	PR
2	2085R0202X	Diagnostic Radiology Physician	31504	PR
3	2085R0204X	Vascular & Interventional Radiology Physician	21094	PR

General Provider Information

NPI Number	:	1962805598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS G. PEREZ PEREZ M.D.

Provider Business Mailing Address
First Line	:	600 AVE JESUS T PINERO APT 2201
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 AVE LAS CUMBRES
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-4818
Country	:	US
Telephone Number	:	787-740-8787
Fax Number	:

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

Provider Enumeration Date	:	09/26/2014
Last Update Date	:	11/18/2020

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