Provider Demographics
NPI:1861155079
Name:PEREA ARISMENDIZ, LASMINA LADIS (MD)
Entity type:Individual
Prefix:
First Name:LASMINA
Middle Name:LADIS
Last Name:PEREA ARISMENDIZ
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:LA RAMBLA 1150
Mailing Address - Street 2:CALLE AVILA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-234-3071
Mailing Address - Fax:
Practice Address - Street 1:LA RAMBLA 1150
Practice Address - Street 2:CALLE AVILA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-234-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR569PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR569PAOtherPHYSITIAN ASSISTANT