Provider Demographics
NPI:1588053821
Name:PEREZ, JOSE (MA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 CALLE BAYAMON APT. 3
Mailing Address - Street 2:URB. LAS CUMBRES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-458-0543
Mailing Address - Fax:
Practice Address - Street 1:478 CALLE BAYAMON APT. 3
Practice Address - Street 2:URB. LAS CUMBRES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-458-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3798103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist