Provider Demographics
NPI:1396249983
Name:PEREZ NEGRON, SASHA (ATOL)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:PEREZ NEGRON
Suffix:
Gender:F
Credentials:ATOL
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 519
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-0519
Mailing Address - Country:US
Mailing Address - Phone:787-709-1717
Mailing Address - Fax:
Practice Address - Street 1:239 SABANETAS IND PK
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4401
Practice Address - Country:US
Practice Address - Phone:939-238-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR905224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR905OtherATOL