Provider Demographics
NPI:1558836882
Name:DE JESUS PEREZ, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DE JESUS PEREZ
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 1:2102 WALDEN PARK CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6302
Mailing Address - Country:US
Mailing Address - Phone:787-662-3362
Mailing Address - Fax:407-483-9551
Practice Address - Street 1:2102 WALDEN PARK CIR APT 303
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-6302
Practice Address - Country:US
Practice Address - Phone:787-662-3362
Practice Address - Fax:407-483-9551
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-13
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other