Provider Demographics
NPI:1730217209
Name:PEREZ, LILLIAM IVETTE
Entity type:Individual
Prefix:
First Name:LILLIAM
Middle Name:IVETTE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 8418
Mailing Address - Street 2:BAYAMON
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9787
Mailing Address - Country:US
Mailing Address - Phone:787-730-8990
Mailing Address - Fax:
Practice Address - Street 1:X1 CALLE 17
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4534
Practice Address - Country:US
Practice Address - Phone:787-620-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5185183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician