Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 017R | PR |
NPI | 1215416169 |
---|---|
Provider Name | Luis A Perez Melean |
First Address | San Juan, PR 00909-5001 |
Second Address | San Juan, PR 00935-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2018 |
Last Update Date | 11/08/2018 |