Basic Information
| Provider Information | |||||||||
| NPI: | 1003255431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ-SANTIAGO | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | CARLOS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | CONDOMINIO ALAMANDA | ||||||||
| Address2: | 70 CALLE ALAMANDA; APT 6184 | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872018979 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | INSTITUTO SAN PABLO | ||||||||
| Address2: | 66 CALLE SANTA CRUZ | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877402270 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2013 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 21372 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.