Provider Demographics
NPI:1306080445
Name:PEREZ, ROSALINDA L (DN)
Entity type:Individual
Prefix:DR
First Name:ROSALINDA
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 N MILWAUKEE AVE
Mailing Address - Street 2:C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2146
Mailing Address - Country:US
Mailing Address - Phone:773-726-1757
Mailing Address - Fax:
Practice Address - Street 1:4803 N MILWAUKEE AVE
Practice Address - Street 2:C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2146
Practice Address - Country:US
Practice Address - Phone:773-726-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000346172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath