Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 4828 | PR |
NPI | 1003882143 |
---|---|
Provider Name | Jose A Perez Hernandez SR. |
First Address | Mayaguez, PR 00681 |
Second Address | Mayaguez, PR 00680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 30/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0391 | IMC (01) | |
065312 | CA (01) | |
97123PE | SSS (01) |