Provider Demographics
NPI:1023649555
Name:PEREZ, INGRID M
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:M
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:CANOVANAS MALL ENRIQUE MANGUAL
Mailing Address - Street 2:LOCAL 14
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-382-7319
Mailing Address - Fax:
Practice Address - Street 1:CANOVANAS MALL ENRIQUE MANGUAL
Practice Address - Street 2:LOCAL 14
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0072
Practice Address - Country:US
Practice Address - Phone:787-382-7319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist