Provider Demographics
NPI:1629835418
Name:PEREZ-SANTOS, MICHELE M (NYCPS-P)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:PEREZ-SANTOS
Suffix:
Gender:F
Credentials:NYCPS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 RIVERDALE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2100
Mailing Address - Country:US
Mailing Address - Phone:718-796-5300
Mailing Address - Fax:
Practice Address - Street 1:5676 RIVERDALE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2100
Practice Address - Country:US
Practice Address - Phone:718-796-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-O-4307175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist