Provider Demographics
NPI:1801509187
Name:PEREZ RODRIGUEZ, TANIA LETICIA
Entity type:Individual
Prefix:MISS
First Name:TANIA
Middle Name:LETICIA
Last Name:PEREZ RODRIGUEZ
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 1:1001 N VERMONT ST APT 203
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4764
Mailing Address - Country:US
Mailing Address - Phone:208-881-3802
Mailing Address - Fax:
Practice Address - Street 1:2921 11TH ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-0827
Practice Address - Country:US
Practice Address - Phone:703-979-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health