Provider Demographics
NPI:1619377322
Name:PEREZ, ANTONIA (NP-PP)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:NP-PP
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:
Other - Last Name:ORTEGA-PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-PP
Mailing Address - Street 1:1890 WAITE STREET STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459
Mailing Address - Country:US
Mailing Address - Phone:541-756-6232
Mailing Address - Fax:541-756-6234
Practice Address - Street 1:1890 WAITE STREET STE 1
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-6232
Practice Address - Fax:541-756-6234
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129913363LF0000X
MDAC001437363LF0000X
DCRN1015425363LF0000X
OR202113062NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1619377322Medicaid