Healthcare Provider Details

I. General information

NPI: 1760681456
Provider Name (Legal Business Name): KATHERINE E PERES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17445 E APSHAWA RD
MINNEOLA FL
34715-9049
US

IV. Provider business mailing address

17445 E APSHAWA RD
MINNEOLA FL
34715-9049
US

V. Phone/Fax

Practice location:
  • Phone: 352-242-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0002498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: