Provider Demographics
NPI:1235265281
Name:PEREZ-OLIVERAS, LOURDES M (PHD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:PEREZ-OLIVERAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB JARDINES DE CASABLANCA CALLE LINCOLN # 150
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3626
Mailing Address - Country:US
Mailing Address - Phone:787-288-2839
Mailing Address - Fax:787-288-2839
Practice Address - Street 1:URB JARDINES DE CASABLANCA CALLE LINCOLN # 150
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3626
Practice Address - Country:US
Practice Address - Phone:787-288-2839
Practice Address - Fax:787-288-2839
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR768OtherPROFESSIONAL LICENSE