MEDICARE: MARLENE PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SI2999	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063961688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE PEREZ

Provider Business Mailing Address
First Line	:	5598 8TH ST W UNIT 3
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-6341
Country	:	US
Telephone Number	:	239-674-9374
Fax Number	:	239-491-3057

Provider Business Practice Location Address
First Line	:	5598 8TH ST W UNIT 3
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33971-6341
Country	:	US
Telephone Number	:	239-674-9374
Fax Number	:	239-491-3057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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Directions to “ MARLENE PEREZ ” Practice Location

Language	Start Address	Practice Location

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