Provider Demographics
NPI:1699890632
Name:PEREZ AYBAR, PEDRO A (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:PEREZ AYBAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:PMB 364 STE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-847-4667
Mailing Address - Fax:787-847-4868
Practice Address - Street 1:BO TIERRA SANTA
Practice Address - Street 2:CARR 149 KM 58.2
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-4667
Practice Address - Fax:787-847-4868
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-42673Medicare UPIN
I-42673Medicare UPIN
PR0085049AMedicare ID - Type Unspecified