Healthcare Provider Details

I. General information

NPI: 1417599879
Provider Name (Legal Business Name): CONCEPCION PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 02/22/2022
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 75TH ST
WILLOWBROOK IL
60527-2366
US

IV. Provider business mailing address

273 SENECA WAY
BOLINGBROOK IL
60440-1738
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-0004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: