Provider Demographics
NPI:1649740523
Name:PEREZ, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 S HIGHWAY 373
Mailing Address - Street 2:
Mailing Address - City:AMARGOSA VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89020-1514
Mailing Address - Country:US
Mailing Address - Phone:775-372-1199
Mailing Address - Fax:
Practice Address - Street 1:1472 S HIGHWAY 373
Practice Address - Street 2:
Practice Address - City:AMARGOSA VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89020-1514
Practice Address - Country:US
Practice Address - Phone:775-372-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker