Provider Demographics
NPI:1619299443
Name:PEREZ, ANGIE E (BSN,CWSCN)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:E
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BSN,CWSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 CALLE JUAN BAIZ
Mailing Address - Street 2:2206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4643
Mailing Address - Country:US
Mailing Address - Phone:787-645-7568
Mailing Address - Fax:
Practice Address - Street 1:1294 CALLE JUAN BAIZ
Practice Address - Street 2:2206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4643
Practice Address - Country:US
Practice Address - Phone:787-645-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR029337163WG0000X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice