Provider Demographics
NPI:1033327804
Name:PEREZ, LILLI ANN (PHD)
Entity Type:Individual
Prefix:
First Name:LILLI
Middle Name:ANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LILLI
Other - Middle Name:PEREZ
Other - Last Name:IYECHAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:LILLI ANN PEREZ, PHD (DBA: FAMILY PACIFIC, INC.)
Mailing Address - Street 2:PO BOX 795
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932
Mailing Address - Country:US
Mailing Address - Phone:671-637-5131
Mailing Address - Fax:
Practice Address - Street 1:BLUE OCEAN MEDICAL GROUP (DBA: INTERNATIONAL HEALTH PRO
Practice Address - Street 2:655 HARMON LOOP ROAD, SUITE 108
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-477-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS-801102L00000X
GUIMF-049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst