Provider Demographics
NPI:1164874830
Name:PEREZ, JANINA ANGELICA I
Entity Type:Individual
Prefix:MISS
First Name:JANINA
Middle Name:ANGELICA
Last Name:PEREZ
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JANINA
Other - Middle Name:ANGELICA
Other - Last Name:PEREZ
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21456 PANAMA ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2816
Mailing Address - Country:US
Mailing Address - Phone:313-888-7920
Mailing Address - Fax:
Practice Address - Street 1:21456 PANAMA ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2816
Practice Address - Country:US
Practice Address - Phone:313-888-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other