Provider Demographics
NPI:1528580941
Name:PEREZ-GARCIA, JACQUELINE (MSED)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PEREZ-GARCIA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 FIELDSTON RD APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2529
Mailing Address - Country:US
Mailing Address - Phone:917-569-4740
Mailing Address - Fax:
Practice Address - Street 1:5550 FIELDSTON RD APT 5C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2529
Practice Address - Country:US
Practice Address - Phone:917-569-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist