Healthcare Provider Details

I. General information

NPI: 1184682122
Provider Name (Legal Business Name): MARIA TERESA PEREZ CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SHF UNIT 21414 BOX 223
APO AE
09705
BE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN; MCEUL-DCCS (CREDENTIALS), CMR 402
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 0113265445970
  • Fax:
Mailing address:
  • Phone: 011496371868839
  • Fax: 011496371866133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL005863L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: