Provider Demographics
NPI:1841522653
Name:PEREZ, VIVIAN VANESSA (DC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:VANESSA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41635 SECT EL FOSFORO
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9421
Mailing Address - Country:US
Mailing Address - Phone:787-244-2352
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 96 H8
Practice Address - Street 2:BO. COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-424-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor