Doctor Name: | JILLIAN ANDERSON PEREZ |
NPI Number: | 1265691620 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 002092 |
Business Practice Address: | 205 Main St East Haven, CT - 065123003 |
Business Phone Number: | 2034665070 |
Business Fax Number: | 2034665075 |
Mailing Address: | 205 Main St, EAST HAVEN |
State: | CT |
Postal Code: | 065123003 |
Phone Number: | 2034665070 |
Fax Number: | 2034665075 |
NPI Enumeration Date: | 06/02/2008 |
NPI Last Update Date: | 11/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 002092 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |