Provider Demographics
NPI:1639932585
Name:PEREZ, LIZA MARIE (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:MARIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 CALLE JUAN B UGALDE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6328
Mailing Address - Country:US
Mailing Address - Phone:787-616-3325
Mailing Address - Fax:
Practice Address - Street 1:1923 CALLE JUAN B UGALDE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6328
Practice Address - Country:US
Practice Address - Phone:787-616-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4495261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech