Doctor Name: | MR. JASON YAMIL PEREZ |
NPI Number: | 1225452097 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | S63796894 |
Business Practice Address: | 142 Crescent St Second Floor Brockton, MA - 023023104 |
Business Phone Number: | 5089410005 |
Business Fax Number: | 5084276915 |
Mailing Address: | 142 Crescent Street, Second Floor BROCKTON |
State: | MA |
Postal Code: | 02302 |
Phone Number: | 5089410005 |
Fax Number: | 5084276915 |
NPI Enumeration Date: | 02/13/2014 |
NPI Last Update Date: | 02/13/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | S63796894 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |