Provider Demographics
NPI:1215910823
Name:BRACERO PEREZ, MAGALY (MD)
Entity type:Individual
Prefix:
First Name:MAGALY
Middle Name:
Last Name:BRACERO PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0882
Mailing Address - Country:US
Mailing Address - Phone:787-851-6407
Mailing Address - Fax:787-851-6407
Practice Address - Street 1:33 CALLE MUNOZ RIVERA
Practice Address - Street 2:SUITE 2
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3538
Practice Address - Country:US
Practice Address - Phone:787-851-6407
Practice Address - Fax:787-851-6407
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14805208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14805OtherSSBV
PRA499OtherINTERNATIONAL MEDICAL CAR
PR6230123OtherHUMANA