Healthcare Provider Details

I. General information

NPI: 1114433836
Provider Name (Legal Business Name): DAMARY I PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WATERMAN ST
DETROIT MI
48209-2022
US

IV. Provider business mailing address

1500 S ANNABELLE ST
DETROIT MI
48217-1266
US

V. Phone/Fax

Practice location:
  • Phone: 313-841-8900
  • Fax: 313-841-3756
Mailing address:
  • Phone: 313-213-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberP626135325618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: