Provider Demographics
NPI:1912098237
Name:PEREZ-CLEMENTI, CAROLINA (P A)
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:PEREZ-CLEMENTI
Suffix:
Gender:F
Credentials:P A
Other - Prefix:MISS
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:P A
Mailing Address - Street 1:9033 ELMHURST AVENUE.
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7935
Mailing Address - Country:US
Mailing Address - Phone:718-457-7000
Mailing Address - Fax:718-899-4955
Practice Address - Street 1:9033 ELMHURST AVENUE.
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7935
Practice Address - Country:US
Practice Address - Phone:718-457-7000
Practice Address - Fax:718-899-4955
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008399363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008399-1OtherLICENSE #
NY008399-1OtherLICENSE #