Provider Demographics
NPI:1942999388
Name:PEREZ, SORELYS GOMEZ
Entity Type:Individual
Prefix:
First Name:SORELYS
Middle Name:GOMEZ
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:ESTANCIAS DE CERRO GORDO
Mailing Address - Street 2:STREET 11 M9
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-690-1788
Mailing Address - Fax:
Practice Address - Street 1:ESTANCIAS DE CERRO GORDO
Practice Address - Street 2:STREET 11 M9
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-690-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10412104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker