Healthcare Provider Details

I. General information

NPI: 1801299417
Provider Name (Legal Business Name): BETHZAIDA PEREZ-KYLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2014
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 5TH ST
DOUGLAS AZ
85607-2859
US

IV. Provider business mailing address

3316 PEREGRINE DR
SIERRA VISTA AZ
85650-6659
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-7659
  • Fax: 520-364-8541
Mailing address:
  • Phone: 520-220-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5754
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: