Provider Demographics
NPI:1548262215
Name:PEREZ, CARMEN ANNA (MD)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ANNA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 RUTA 474
Mailing Address - Street 2:BO. GALATEO BAJO
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3948
Mailing Address - Country:US
Mailing Address - Phone:787-872-1887
Mailing Address - Fax:787-872-1887
Practice Address - Street 1:CARR. 474 BARRIO GALATEO BAJO
Practice Address - Street 2:BUZON 181
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3948
Practice Address - Country:US
Practice Address - Phone:787-872-1887
Practice Address - Fax:787-872-1887
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10727208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0082949Medicare ID - Type Unspecified
PRF47621Medicare UPIN