Provider Demographics
NPI:1346993003
Name:PEREZ, TITA LYNETTE
Entity Type:Individual
Prefix:
First Name:TITA
Middle Name:LYNETTE
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 1:67 KANIAU RD
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1836
Mailing Address - Country:US
Mailing Address - Phone:760-782-7621
Mailing Address - Fax:
Practice Address - Street 1:67 KANIAU RD
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1836
Practice Address - Country:US
Practice Address - Phone:760-782-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist