Provider Demographics
NPI:1861581712
Name:PEREZ PABON, MIRIAM T (DR)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:T
Last Name:PEREZ PABON
Suffix:
Gender:F
Credentials:DR
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 366782
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6782
Mailing Address - Country:US
Mailing Address - Phone:787-649-3088
Mailing Address - Fax:
Practice Address - Street 1:#8 ISIDRO RODRIGUEZ STREET
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962
Practice Address - Country:US
Practice Address - Phone:787-788-7680
Practice Address - Fax:787-788-7695
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083137Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
PRG01259Medicare UPIN