1982610697 NPI number — MRS. YANESA M PEREZ BERRIOS MD

Table of content: MRS. YANESA M PEREZ BERRIOS MD (NPI 1982610697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982610697 NPI number — MRS. YANESA M PEREZ BERRIOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ BERRIOS
Provider First Name:
YANESA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
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:
PEREZ BERRIOS
Provider Other First Name:
YANESA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982610697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7886
Provider Second Line Business Mailing Address:
PMB 367
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00970-7886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-765-1039
Provider Business Mailing Address Fax Number:
787-765-6197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 AVE WINSTON CHURCHILL
Provider Second Line Business Practice Location Address:
W CHURCHILL 2000 BLDG OF 201
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-6651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-765-1039
Provider Business Practice Location Address Fax Number:
787-765-6197
Provider Enumeration Date:
08/01/2006

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: 207W00000X , with the licence number:  11506 , 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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