Basic Information
| Provider Information | |||||||||
| NPI: | 1598116881 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DORNA PEREZ | ||||||||
| FirstName: | LUISAMARI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2116 | ||||||||
| Address2: | UNIVERSITY DISTRICT HOSPITAL PUERTO RICO MEDICAL CENTER | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009222116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY DISTRICT HOSPITAL PUERTO RICO MEDICAL CENTER | ||||||||
| Address2: | BO. MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2016 | ||||||||
| LastUpdateDate: | 07/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4847418 | PR | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | 4847418 | PR | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.