Provider Demographics
NPI:1609134493
Name:PEREZ, TIRZA Y
Entity Type:Individual
Prefix:
First Name:TIRZA
Middle Name:Y
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 1:3732 CHEROKEE AVE EAST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3516
Mailing Address - Country:US
Mailing Address - Phone:702-358-3106
Mailing Address - Fax:
Practice Address - Street 1:4560 S. EASTERN AVENUE STE 15
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-401-0811
Practice Address - Fax:702-947-6337
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner