Provider Demographics
NPI:1770002636
Name:L. PEREZ DE PONCE
Entity Type:Organization
Organization Name:L. PEREZ DE PONCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAYDE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREZ DE PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:402-616-2718
Mailing Address - Street 1:14421 DUPONT CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2100
Mailing Address - Country:US
Mailing Address - Phone:402-886-6400
Mailing Address - Fax:402-504-6614
Practice Address - Street 1:14421 DUPONT CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2100
Practice Address - Country:US
Practice Address - Phone:402-884-6400
Practice Address - Fax:402-504-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty