Provider Demographics
NPI:1639263601
Name:PEREZ, FRANK J (SLP)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:PEREZ
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4569 N PASEO BOCOANCOS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1702
Mailing Address - Country:US
Mailing Address - Phone:520-906-8548
Mailing Address - Fax:520-577-2686
Practice Address - Street 1:4569 N PASEO BOCOANCOS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1702
Practice Address - Country:US
Practice Address - Phone:520-906-8548
Practice Address - Fax:520-577-2686
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ318297Medicaid