Healthcare Provider Details

I. General information

NPI: 1215855408
Provider Name (Legal Business Name): RICARDO PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 31ST ST
MOUNT RAINIER MD
20712-1732
US

IV. Provider business mailing address

4220 31ST ST
MOUNT RAINIER MD
20712-1732
US

V. Phone/Fax

Practice location:
  • Phone: 361-759-1020
  • Fax:
Mailing address:
  • Phone: 361-759-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200004741
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: