Provider Demographics
NPI:1285973156
Name:PEREZ, RAFAELINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RAFAELINA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 UNIVERSITY BLVD
Mailing Address - Street 2:5H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6901
Mailing Address - Country:US
Mailing Address - Phone:646-319-8985
Mailing Address - Fax:
Practice Address - Street 1:9110 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4301
Practice Address - Country:US
Practice Address - Phone:718-617-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist