Healthcare Provider Details

I. General information

NPI: 1528376969
Provider Name (Legal Business Name): SANDRA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO QUEBRADA CARR 127 KM 7.1
GUAYANILLA PR
00656-4335
US

IV. Provider business mailing address

PO BOX 561895
GUAYANILLA PR
00656-4335
US

V. Phone/Fax

Practice location:
  • Phone: 787-380-4396
  • Fax: 787-844-4130
Mailing address:
  • Phone: 787-380-4396
  • Fax: 787-844-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number22103
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: