Healthcare Provider Details

I. General information

NPI: 1942669684
Provider Name (Legal Business Name): DANIEL PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 S 148TH ST
TUKWILA WA
98168-4319
US

IV. Provider business mailing address

13925 INTERURBAN AVE S STE 120
TUKWILA WA
98168-5718
US

V. Phone/Fax

Practice location:
  • Phone: 206-832-8518
  • Fax:
Mailing address:
  • Phone: 206-715-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW60946098
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: