Provider Demographics
NPI:1124895859
Name:PEREZ, ITZARITZA SOLIMAR (MSW)
Entity type:Individual
Prefix:
First Name:ITZARITZA
Middle Name:SOLIMAR
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STREERT MAGA 114
Practice Address - Street 2:MONTEFIORI
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-8125
Practice Address - Country:US
Practice Address - Phone:787-426-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR148741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical