Healthcare Provider Details

I. General information

NPI: 1003453069
Provider Name (Legal Business Name): KRYSTAL LEE PEREZ-MARTINEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 04/30/2024
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CALLE LEDESMA
UTUADO PR
00641
US

IV. Provider business mailing address

127 CALLE ANGELITO NIEVES
AGUADILLA PR
00603-5819
US

V. Phone/Fax

Practice location:
  • Phone: 787-433-2828
  • Fax:
Mailing address:
  • Phone: 787-902-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15305
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: