Provider Demographics
NPI:1659149631
Name:PEREZ, DIEGO A
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C 1ALTURAS SAN PATRICIO
Mailing Address - Street 2:EXT #17
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-422-6122
Mailing Address - Fax:
Practice Address - Street 1:AQ35 AVE LAUREL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4725
Practice Address - Country:US
Practice Address - Phone:787-400-6000
Practice Address - Fax:787-400-6000
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRRBT23-286674106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician