Provider Demographics
NPI:1588404859
Name:PEREZ, LUIS ENRIQUE SR
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:PEREZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 W AILEEN ST # 33607
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1814
Mailing Address - Country:US
Mailing Address - Phone:504-518-1848
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MONACILLOS #150 SAN JUAN PR 00935-5006
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program