Healthcare Provider Details

I. General information

NPI: 1912001173
Provider Name (Legal Business Name): LEON SOCORRO PEREZ L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 EUCLID RD.
GRANDVIEW WA
98930-1160
US

IV. Provider business mailing address

2807 FRASER WAY
YAKIMA WA
98902-4065
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-7888
  • Fax: 509-882-6588
Mailing address:
  • Phone: 509-882-7888
  • Fax: 509-882-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017644
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: