Basic Information
| Provider Information | |||||||||
| NPI: | 1699055772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ-GOMEZ | ||||||||
| FirstName: | VIVIAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | CALLE GUADALUPE FINAL, DEPARTAMENTO DE EMERGENCIA | ||||||||
| Address2: | HOSPITAL SAN LUCAS | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00731 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | CALLE GUADALUPE FINAL, DEPARTAMENTO DE EMERGENCIA | ||||||||
| Address2: | HOSPITAL SAN LUCAS | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2011 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 18606 | PR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.