Healthcare Provider Details

I. General information

NPI: 1013783505
Provider Name (Legal Business Name): PERLA ALCANTARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST FL 2
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

465 GRAND ST FL 2
NEW YORK NY
10002-4800
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1999
  • Fax: 212-420-1910
Mailing address:
  • Phone: 212-420-1999
  • Fax: 212-420-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: