Healthcare Provider Details

I. General information

NPI: 1982910105
Provider Name (Legal Business Name): BETSAIDA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HCO1 BOX 9761 BO TALLABOA ALTA SECTOR LA MOCA
PENUELAS PR
00624
US

IV. Provider business mailing address

HCO1 BOX 9761 BO TALLABOA ALTA SECTOR LA MOCA
PENUELAS PR
00624
US

V. Phone/Fax

Practice location:
  • Phone: 787-391-7876
  • Fax: 787-844-4130
Mailing address:
  • Phone: 787-391-7876
  • Fax: 787-844-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACII15622376
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: