Healthcare Provider Details

I. General information

NPI: 1932017340
Provider Name (Legal Business Name): JESSIKA PEREZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 WEALTHY ST SE PMB 112
EAST GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

2153 WEALTHY ST SE PMB 112
EAST GRAND RAPIDS MI
49506
US

V. Phone/Fax

Practice location:
  • Phone: 616-843-0439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: