Provider Demographics
NPI:1467852251
Name:PEREZ, DORA (MS, ANP)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 5TH AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4308
Mailing Address - Country:US
Mailing Address - Phone:646-580-3538
Mailing Address - Fax:844-841-8382
Practice Address - Street 1:25 5TH AVE APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4308
Practice Address - Country:US
Practice Address - Phone:646-580-3538
Practice Address - Fax:844-841-8382
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-306934363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health