Healthcare Provider Details

I. General information

NPI: 1922765403
Provider Name (Legal Business Name): MARIA RIZA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W CAMPUS DR
ORANGE CT
06477-3693
US

IV. Provider business mailing address

41 CABOT ST APT 1
NEW HAVEN CT
06513-4601
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4708
  • Fax:
Mailing address:
  • Phone: 203-715-7778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10041
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: