Organization
PPL MEDICAL CSP
Active
Organization
PPL MEDICAL CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMINGO A. PEREZ M.D. (PRESIDENT)
(787) 779-0484
Entity
Organization
Contact information
Practice address
68 SANTA CRUZ ST., SUITE 405, BAYAMON, PR 00961-7036
(787) 779-0484
(787) 779-3065
Mailing address
100 GRAND BULEVARD PASEOS, SUITE 112 MSC 333, SAN JUAN, PR 00926-5955
(787) 779-0484
(787) 779-3065
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
9828
PR
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
261Q00000X
Clinic/Center
9686
PR
Other
Enumeration date
05/19/2009
Last updated
04/30/2014
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