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General NPI Number Information
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NPI Number | 1831811124
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Entity Type | Individual
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Provider Name | ALYSHAA MARIE AGBULOS PEREZ FNP
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 156 HENRY ST
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City | BROOKLYN
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State | NY
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Zip | 11201-2504
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 5620 DE LONGPRE AVE APT 715
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City | LOS ANGELES
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State | CA
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Zip | 90028-8747
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Country | US
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Telephone | 773-414-3521
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 350369
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95026066
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209025907
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License Number State | IL
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