Healthcare Provider Details

I. General information

NPI: 1013989763
Provider Name (Legal Business Name): ALEXANDRA SUSANA PEREZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY ST SMITH BUILDING 271
BOSTON MA
02115-6013
US

IV. Provider business mailing address

46 CAROLINA AVE APT #3
JAMAICA PLAIN MA
02130-3213
US

V. Phone/Fax

Practice location:
  • Phone: 617-582-8283
  • Fax: 617-582-8305
Mailing address:
  • Phone: 617-522-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: