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General NPI Number Information
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NPI Number | 1356774897
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Entity Type | Organization
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Legal Business Name | TULLA PEREZ INC
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 39 PINE ST
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City | NEW CANAAN
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State | CT
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Zip | 06840-5409
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Country | US
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Telephone | 203-972-7546
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Fax | 203-972-5937
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Provider Business Mailing Address
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Address Line | 38 TOMMYS LN
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City | NEW CANAAN
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State | CT
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Zip | 06840-6332
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Country | US
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Telephone | 203-972-3802
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARITZA IVONNE PEREZ
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Credential | MD
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Telephone | 203-984-3101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 27844
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 27844
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License Number State | CT
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