Provider Demographics
NPI:1518140227
Name:PEREZ, WALESKA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1419
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1419
Mailing Address - Country:US
Mailing Address - Phone:787-233-5910
Mailing Address - Fax:
Practice Address - Street 1:#152 CALLE MANUEL ZENO GANDIA
Practice Address - Street 2:# 152
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0152
Practice Address - Country:US
Practice Address - Phone:787-233-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PR3020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085471Medicare UPIN