Provider Demographics
NPI:1598303745
Name:PEREZ, MARICA L
Entity Type:Individual
Prefix:
First Name:MARICA
Middle Name:L
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 1:3949 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4746
Mailing Address - Country:US
Mailing Address - Phone:541-882-1487
Mailing Address - Fax:541-880-5590
Practice Address - Street 1:635 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6007
Practice Address - Country:US
Practice Address - Phone:541-882-1487
Practice Address - Fax:541-884-1851
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator