Provider Demographics
NPI:1487791323
Name:PEREZ CABAN, WILFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:PEREZ CABAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:CALLE DON CHEMARY #103
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00676
Mailing Address - Country:UM
Mailing Address - Phone:787-818-5023
Mailing Address - Fax:787-818-5023
Practice Address - Street 1:CALLE DON CHEMARY 103
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00676
Practice Address - Country:UM
Practice Address - Phone:787-818-5023
Practice Address - Fax:787-818-5023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7094OtherM.D. LICENSE
AP2453570OtherDEA
PR7094OtherM.D. LICENSE
PRC77600Medicare UPIN