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General NPI Number Information
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NPI Number | 1851711378
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Entity Type | Individual
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Provider Name | IDALI PEREZ
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Gender | Female
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | LOCAL LOIZA VALLEY SHOPPING CENTER AA6
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City | CANOVANAS
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State | PUERTO RICO
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Zip | 00729
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Country | UM
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Telephone | 787-256-0273
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Fax | 787-876-7856
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Provider Business Mailing Address
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Address Line | PO BOX 9915 LOCAL AA6 LOIZA VALLEY SHOPPING CENTER
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City | CANOVANAS
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State | PR
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Zip | 00729
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Country | US
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Telephone | 787-256-0273
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Fax | 787-876-7856
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10674
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License Number State | PR
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