Provider Demographics
NPI:1154575512
Name:PEREZ, AIXA A (PSYD)
Entity type:Individual
Prefix:DR
First Name:AIXA
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AIXA
Other - Middle Name:A
Other - Last Name:PEREZ RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1175
Mailing Address - Country:US
Mailing Address - Phone:787-432-6735
Mailing Address - Fax:
Practice Address - Street 1:63 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0660
Practice Address - Country:US
Practice Address - Phone:787-898-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3072103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical