Provider Demographics
NPI:1598050304
Name:PEREZ, LISA (CSA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7360 SERENITY PL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-2261
Mailing Address - Country:US
Mailing Address - Phone:678-689-8706
Mailing Address - Fax:470-239-3092
Practice Address - Street 1:7360 SERENITY PL
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2261
Practice Address - Country:US
Practice Address - Phone:678-689-8706
Practice Address - Fax:470-239-3092
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
246ZC0007X
984363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant