Provider Demographics
NPI:1346880788
Name:PEREZ, JULIENNE NASCIMENTO (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JULIENNE
Middle Name:NASCIMENTO
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 MILLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1795
Mailing Address - Country:US
Mailing Address - Phone:702-508-1506
Mailing Address - Fax:
Practice Address - Street 1:211A N 18TH ST # 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6905
Practice Address - Country:US
Practice Address - Phone:702-508-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019013425225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist