Provider Demographics
NPI:1700510997
Name:PEREZ QUIROS, LAURA MARCELA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARCELA
Last Name:PEREZ QUIROS
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 1:310 E 500 S APT 401
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3360
Mailing Address - Country:US
Mailing Address - Phone:712-840-1492
Mailing Address - Fax:
Practice Address - Street 1:615 S ARAPEEN DR STE 212
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1243
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS