Provider Demographics
NPI:1285355024
Name:PEREZ COLON, MIRELYS MARIE
Entity type:Individual
Prefix:
First Name:MIRELYS
Middle Name:MARIE
Last Name:PEREZ COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 9106
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9004
Mailing Address - Country:US
Mailing Address - Phone:787-527-9087
Mailing Address - Fax:
Practice Address - Street 1:BO CAONILLAS ABAJO, SECT. CERRO GORDO
Practice Address - Street 2:CARR. 150 INT. 5520
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-527-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7045103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty