Healthcare Provider Details

I. General information

NPI: 1780612986
Provider Name (Legal Business Name): DANAE PEREZ-CAHILL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST VA MEDICAL CENTER
BOISE ID
83702-4501
US

IV. Provider business mailing address

500 W FORT ST VA MEDICAL CENTER
BOISE ID
83702-4501
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax: 208-422-1496
Mailing address:
  • Phone: 208-422-1000
  • Fax: 208-422-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number7730
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7730
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: