Provider Demographics
NPI:1043658289
Name:PEREZ, YANIRA A (MAT)
Entity Type:Individual
Prefix:
First Name:YANIRA
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1013
Mailing Address - Country:US
Mailing Address - Phone:630-352-8306
Mailing Address - Fax:888-333-7964
Practice Address - Street 1:817 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1013
Practice Address - Country:US
Practice Address - Phone:630-352-8306
Practice Address - Fax:888-333-7964
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist