Healthcare Provider Details

I. General information

NPI: 1447848098
Provider Name (Legal Business Name): ILIANI PEREZ RODRIGUEZ LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD STE 215
LANSING MI
48910-6825
US

IV. Provider business mailing address

812 E JOLLY RD STE 210
LANSING MI
48910-6825
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801104723
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: