MEDICARE: CATALINA M PEREZ-LACEY MD PA

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	2084P0800X	Psychiatry Physician

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	:	1679858955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATALINA M PEREZ-LACEY MD PA

Provider Business Mailing Address
First Line	:	3439 NE SANDY BLVD
Second Line	:	PMB 375
City	:	PORTLAND
State	:	OR
Zip	:	97232-1959
Country	:	US
Telephone Number	:	503-284-8841
Fax Number	:	503-282-3302

Provider Business Practice Location Address
First Line	:	103 S SAINT FRANCIS DR
Second Line	:	SUITE C
City	:	SANTA FE
State	:	NM
Zip	:	87501-2458
Country	:	US
Telephone Number	:	505-466-8428
Fax Number	:	505-466-8428

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CATALINA PEREZ-LACEY
Credential	:	M.D.,
Telephone Number	:	505-466-8428

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	12/14/2011

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