1316094196 NPI number — ROBERTO PEREZ CARRIL

Table of content: (NPI 1316094196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316094196 NPI number — ROBERTO PEREZ CARRIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERTO PEREZ CARRIL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316094196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-896-6340
Provider Business Mailing Address Fax Number:
787-896-3036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR.# 111 KM. 14.5 PLAZA HATO ARRIBA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-896-6340
Provider Business Practice Location Address Fax Number:
787-896-3036
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ CARRIL
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-896-6340

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 037673300 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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