Healthcare Provider Details

I. General information

NPI: 1982978912
Provider Name (Legal Business Name): DENNISSE M PEREZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. ROOSEVELT 403 CALLE PEDRO ESPADA STE. 3
HATO REY PR
00918-2800
US

IV. Provider business mailing address

ALTURAS DE FLAMBOYAN 19 ST. GG-19
BAYAMON PR
00959-8066
US

V. Phone/Fax

Practice location:
  • Phone: 787-294-6849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4164
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: