Provider Demographics
NPI:1316094196
Name:ROBERTO PEREZ CARRIL
Entity type:Organization
Organization Name:ROBERTO PEREZ CARRIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ CARRIL
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-896-6340
Mailing Address - Street 1:PO BOX 1346
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1346
Mailing Address - Country:US
Mailing Address - Phone:787-896-6340
Mailing Address - Fax:787-896-3036
Practice Address - Street 1:CARR.# 111 KM. 14.5 PLAZA HATO ARRIBA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3005
Practice Address - Country:US
Practice Address - Phone:787-896-6340
Practice Address - Fax:787-896-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037673300Medicaid