Provider Demographics
NPI:1851711378
Name:PEREZ, IDALI
Entity Type:Individual
Prefix:
First Name:IDALI
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:PO BOX 9915
Mailing Address - Street 2:LOCAL AA6 LOIZA VALLEY SHOPPING CENTER
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-256-0273
Mailing Address - Fax:787-876-7856
Practice Address - Street 1:LOCAL LOIZA VALLEY SHOPPING CENTER
Practice Address - Street 2:AA6
Practice Address - City:CANOVANAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00729
Practice Address - Country:UM
Practice Address - Phone:787-256-0273
Practice Address - Fax:787-876-7856
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10764OtherSOCIAL WORKER