Provider Information for 1245508613
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MARIA IVETTE PEREZ
Sex: Female
NPI: 1245508613
Last Updated: 2011-12-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1245508613 | ||||||||
| Enumeration Date | 2011-12-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 14 FORDHAM RD ALLSTON, MA 02134-3006 United States Phone: 617-782-6460 | Fax: | ||||||||
| Primary Practice Address | 14 FORDHAM RD ALLSTON, MA 02134-3006 United States Phone: 617-782-6460 | Fax: | ||||||||
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