Provider Demographics
NPI:1487335659
Name:PEREZ, JAHAIRA (RD)
Entity type:Individual
Prefix:
First Name:JAHAIRA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PHILIP AVE # 2
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2136
Mailing Address - Country:US
Mailing Address - Phone:201-790-6757
Mailing Address - Fax:
Practice Address - Street 1:115 PHILIP AVE # 2
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-2136
Practice Address - Country:US
Practice Address - Phone:201-790-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86171293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered