Active NPI
Jaclyn Perez
- School Psychologist
- Vega Alta, PR
National Provider Identifier
1124334727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 3630
- Practice address
- Vega Alta Community Health St. #2 KM 31.4 Bario Bajuras
Vega Alta, PR 00692-5835 - Phone
- (939) 969-7529
- NPI assigned
- Aug 20, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 899 | PR | |
| School Psychologist | 103TS0200X | 3630 | PR | Primary |
Addresses
Primary practice location
Vega Alta Community Health St. #2 KM 31.4 Bario Bajuras
Vega Alta, PR 00692-5835
Mailing address
Vega Alta Community Health St. #2 KM 31.4 Bario Bajuras
Vega Alta, PR 00692-5835
Phone (939) 969-7529
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 899 | PR | MD | Dentist |
| 3630 | PR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282262400000",
"number": "1124334727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "VEGA ALTA COMMUNITY HEALTH ST. #2 KM 31.4 BARIO BAJURAS",
"city": "VEGA ALTA",
"state": "PR",
"postal_code": "006925835",
"telephone_number": "939-969-7529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "VEGA ALTA COMMUNITY HEALTH ST. #2 KM 31.4 BARIO BAJURAS",
"city": "VEGA ALTA",
"state": "PR",
"postal_code": "006925835",
"telephone_number": "939-969-7529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "JACLYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-20",
"last_updated": "2010-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "PR",
"license": "899",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "PR",
"license": "3630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vega Alta, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.