Provider Demographics
NPI:1982408738
Name:PEREZ GARCIA, ZEQUIELIS M
Entity type:Individual
Prefix:
First Name:ZEQUIELIS
Middle Name:M
Last Name:PEREZ GARCIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GLEN CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1405
Mailing Address - Country:US
Mailing Address - Phone:630-945-1293
Mailing Address - Fax:
Practice Address - Street 1:117 GLEN CROSSING RD
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1405
Practice Address - Country:US
Practice Address - Phone:321-441-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician