Healthcare Provider Details

I. General information

NPI: 1790519858
Provider Name (Legal Business Name): YESENIA GUZMAN PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MANHATTAN AVE UNIT 1
JERSEY CITY NJ
07307-3811
US

IV. Provider business mailing address

137 MANHATTAN AVE UNIT 1
JERSEY CITY NJ
07307-3811
US

V. Phone/Fax

Practice location:
  • Phone: 347-759-4147
  • Fax:
Mailing address:
  • Phone: 347-759-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01515800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: