Healthcare Provider Details

I. General information

NPI: 1619079498
Provider Name (Legal Business Name): MRS. REBECA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S8 CALLE 6 SANS SOUCI
BAYAMON PR
00957-4318
US

IV. Provider business mailing address

S8 CALLE 6 SANS SOUCI
BAYAMON PR
00957-4318
US

V. Phone/Fax

Practice location:
  • Phone: 787-797-3786
  • Fax:
Mailing address:
  • Phone: 787-797-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8110
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: