Healthcare Provider Details

I. General information

NPI: 1023946290
Provider Name (Legal Business Name): WINSTON PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOUNT PLEASANT AVE # 9
PROVIDENCE RI
02908-1940
US

IV. Provider business mailing address

80 GARFIELD AVE APT E
CRANSTON RI
02920-7819
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-8042
  • Fax:
Mailing address:
  • Phone: 508-410-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: