Provider Demographics
NPI:1447395157
Name:PEREZ, LUISA DIMARIS
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:DIMARIS
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 1:3490 NEW FAWN LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4438
Mailing Address - Country:US
Mailing Address - Phone:305-761-5505
Mailing Address - Fax:
Practice Address - Street 1:7425 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4402
Practice Address - Country:US
Practice Address - Phone:305-626-5999
Practice Address - Fax:305-262-8999
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8874235Z00000X
GASLP010991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist