Provider Demographics
NPI:1326724204
Name:PEREZ ALICEA, XIDALYS MARIE (NL)
Entity Type:Individual
Prefix:
First Name:XIDALYS
Middle Name:MARIE
Last Name:PEREZ ALICEA
Suffix:
Gender:F
Credentials:NL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F5 CALLE 3 VILLAS DE SAN AGUSTIN
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-317-7648
Mailing Address - Fax:
Practice Address - Street 1:F5 CALLE 3 VILLAS DE SAN AGUSTIN
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-317-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000237175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath