Provider Demographics
NPI:1386742344
Name:PEREZ, AIZA Y (FPH)
Entity type:Individual
Prefix:
First Name:AIZA
Middle Name:Y
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FPH
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 57
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0057
Mailing Address - Country:US
Mailing Address - Phone:787-375-0430
Mailing Address - Fax:787-818-4307
Practice Address - Street 1:124 CALLE CONCEPCION VERA
Practice Address - Street 2:BO PUEBLO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4813
Practice Address - Country:US
Practice Address - Phone:787-877-0110
Practice Address - Fax:787-877-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist