Provider Demographics
NPI:1679858955
Name:CATALINA M PEREZ-LACEY MD PA
Entity Type:Organization
Organization Name:CATALINA M PEREZ-LACEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-LACEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:505-466-8428
Mailing Address - Street 1:3439 NE SANDY BLVD
Mailing Address - Street 2:PMB 375
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1959
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:103 S SAINT FRANCIS DR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2458
Practice Address - Country:US
Practice Address - Phone:505-466-8428
Practice Address - Fax:505-466-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16576Medicaid
NM16576Medicaid
NM029342022PMedicare PIN