Healthcare Provider Details

I. General information

NPI: 1356774897
Provider Name (Legal Business Name): TULLA PEREZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 PINE ST
NEW CANAAN CT
06840-5409
US

IV. Provider business mailing address

38 TOMMYS LN
NEW CANAAN CT
06840-6332
US

V. Phone/Fax

Practice location:
  • Phone: 203-972-7546
  • Fax: 203-972-5937
Mailing address:
  • Phone: 203-972-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number27844
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number27844
License Number StateCT

VIII. Authorized Official

Name: DR. MARITZA IVONNE PEREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 203-984-3101