MEDICARE: LUZ LILLIAN PEREZ PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0-10239	NY

General Provider Information

NPI Number	:	1801105069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ LILLIAN PEREZ PH.D

Provider Business Mailing Address
First Line	:	PO BOX 672191
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-0804
Country	:	US
Telephone Number	:	646-271-1014
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 E GUN HILL RD
Second Line	:	5P
City	:	BRONX
State	:	NY
Zip	:	10467-2120
Country	:	US
Telephone Number	:	646-271-1014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/06/2010

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