=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912042243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER E PEREZ PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 266 AVE LAURO PINERO
-----------------------------------------------------
City | CEIBA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00735-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-885-3010
-----------------------------------------------------
Fax | 787-885-1595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB LOS PINOS D4
-----------------------------------------------------
City | HUMACAO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-930-4906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247200000X
-----------------------------------------------------
Taxonomy Name | Other Technician
-----------------------------------------------------
License Number | 4284
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------