Provider Demographics
NPI:1982910105
Name:PEREZ, BETSAIDA
Entity Type:Individual
Prefix:
First Name:BETSAIDA
Middle Name:
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:HCO1 BOX 9761
Mailing Address - Street 2:BO TALLABOA ALTA SECTOR LA MOCA
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624
Mailing Address - Country:US
Mailing Address - Phone:787-391-7876
Mailing Address - Fax:787-844-4130
Practice Address - Street 1:HCO1 BOX 9761
Practice Address - Street 2:BO TALLABOA ALTA SECTOR LA MOCA
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-391-7876
Practice Address - Fax:787-844-4130
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRACII15622376101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)