Provider Demographics
NPI:1528376969
Name:PEREZ, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
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:PO BOX 561895
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-4335
Mailing Address - Country:US
Mailing Address - Phone:787-380-4396
Mailing Address - Fax:787-844-4130
Practice Address - Street 1:BARRIO QUEBRADA CARR 127 KM 7.1
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-4335
Practice Address - Country:US
Practice Address - Phone:787-380-4396
Practice Address - Fax:787-844-4130
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PR22103163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)