Healthcare Provider Details

I. General information

NPI: 1609278191
Provider Name (Legal Business Name): PATRICIA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 ROANOKE DR NE
RIO RANCHO NM
87144-5551
US

IV. Provider business mailing address

1988 ROANOKE DR NE
RIO RANCHO NM
87144-5551
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-8596
  • Fax:
Mailing address:
  • Phone: 505-550-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: