Healthcare Provider Details

I. General information

NPI: 1891761334
Provider Name (Legal Business Name): EVANGELINE PEREZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 84TH ST 1ST FL
BROOKLYN NY
11209-4701
US

IV. Provider business mailing address

515 84TH ST 1ST FL
BROOKLYN NY
11209-4701
US

V. Phone/Fax

Practice location:
  • Phone: 347-497-4984
  • Fax: 347-497-4980
Mailing address:
  • Phone: 347-497-4984
  • Fax: 347-497-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number222603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: