Provider Demographics
NPI:1174885875
Name:PEREZ, MERCEDES A (MA)
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16213 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1812
Mailing Address - Country:US
Mailing Address - Phone:917-304-9224
Mailing Address - Fax:
Practice Address - Street 1:16213 65TH AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1812
Practice Address - Country:US
Practice Address - Phone:917-304-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist