Healthcare Provider Details

I. General information

NPI: 1619645728
Provider Name (Legal Business Name): SULY D PEREZ-GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E D ST STE 5
YAKIMA WA
98901-2300
US

IV. Provider business mailing address

811 S FAIR AVE
YAKIMA WA
98901-4615
US

V. Phone/Fax

Practice location:
  • Phone: 509-965-7100
  • Fax:
Mailing address:
  • Phone: 509-480-5839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: