Provider Demographics
NPI:1164282729
Name:PEREZ ALBINO, ILEANMARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ILEANMARIE
Middle Name:
Last Name:PEREZ ALBINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CALLE MCKINLEY W UNIT 842
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-5032
Mailing Address - Country:US
Mailing Address - Phone:787-439-4792
Mailing Address - Fax:
Practice Address - Street 1:ROAD # 2 KM 173.4
Practice Address - Street 2:BO CAIN BAJO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001834363AM0700X
PR390200000X
PR24502208D00000X
PR8694246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist