Healthcare Provider Details

I. General information

NPI: 1295955425
Provider Name (Legal Business Name): RAFAEL ALBERTO PEREZ SCM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215-217 WEST 135 STREET
NEW NORK NY
10030
US

IV. Provider business mailing address

300 E 201ST ST BSMT
BRONX NY
10458-1826
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-3500
  • Fax: 212-694-4998
Mailing address:
  • Phone: 212-694-3500
  • Fax: 212-694-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: