Healthcare Provider Details

I. General information

NPI: 1639446495
Provider Name (Legal Business Name): JASMINE PEREZ CD(DONA), IBCLC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E SPENCER LN
GALLOWAY NJ
08205-3256
US

IV. Provider business mailing address

302 E SPENCER LN
GALLOWAY NJ
08205-3256
US

V. Phone/Fax

Practice location:
  • Phone: 917-569-6564
  • Fax:
Mailing address:
  • Phone: 917-569-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number26NR14457000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00050100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: