Healthcare Provider Details

I. General information

NPI: 1144459025
Provider Name (Legal Business Name): MRS. DAHLIA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E OLIVE ST
DEMING NM
88030-4747
US

IV. Provider business mailing address

445 BUCKBOARD RD SW
DEMING NM
88030-7928
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-4515
  • Fax:
Mailing address:
  • Phone: 575-494-5816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-06284
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: