Provider Demographics
NPI:1275932030
Name:PEREZ, YVELISSE M
Entity Type:Individual
Prefix:
First Name:YVELISSE
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 SEDGWICK AVE
Mailing Address - Street 2:APT 5B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3120
Mailing Address - Country:US
Mailing Address - Phone:347-920-2920
Mailing Address - Fax:
Practice Address - Street 1:2741 SEDGWICK AVE
Practice Address - Street 2:APT 5B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3120
Practice Address - Country:US
Practice Address - Phone:347-920-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist