Provider Demographics
NPI:1811684269
Name:PEREZ, MANUEL ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ALEJANDRO
Last Name:PEREZ
Suffix:
Gender:M
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:PO BOX 366402
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6402
Mailing Address - Country:US
Mailing Address - Phone:787-253-7202
Mailing Address - Fax:
Practice Address - Street 1:4745 AVE. ISLA VERDE
Practice Address - Street 2:COND. VILLAS DEL MAR ESTE APT. 17C
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-238-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program