1073575833 NPI number — DR. GILDA B PEREZ MORENO MD

Table of content: DR. GILDA B PEREZ MORENO MD (NPI 1073575833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073575833 NPI number — DR. GILDA B PEREZ MORENO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ MORENO
Provider First Name:
GILDA
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1073575833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 CALLE VENUS
Provider Second Line Business Mailing Address:
PISO 2 URB. ATLANTIC VIEW
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00979-4805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-649-9348
Provider Business Mailing Address Fax Number:
787-268-7237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR 1 CALLE 12
Provider Second Line Business Practice Location Address:
SUITE 3 BARRIO CANA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00957-6245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-649-9348
Provider Business Practice Location Address Fax Number:
787-268-7237
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  15583 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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