Provider Demographics
NPI:1518654342
Name:PEREZ ORTIZ, LIZETH SOLEDAD (SA-C CSA CSA CST)
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:SOLEDAD
Last Name:PEREZ ORTIZ
Suffix:
Gender:F
Credentials:SA-C CSA CSA CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23536 W 90TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-5523
Mailing Address - Country:US
Mailing Address - Phone:620-309-1585
Mailing Address - Fax:
Practice Address - Street 1:23351 PRAIRIE STAR PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227
Practice Address - Country:US
Practice Address - Phone:913-676-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty