Provider Demographics
NPI:1063299527
Name:PEREZ, JACOB DANIEL (MSAT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24063 S BURR RD
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5205
Mailing Address - Country:US
Mailing Address - Phone:815-545-2129
Mailing Address - Fax:
Practice Address - Street 1:347 S GLADSTONE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4877
Practice Address - Country:US
Practice Address - Phone:630-892-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program