1033327804 NPI number — LILLI ANN PEREZ PH.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033327804 NPI number — LILLI ANN PEREZ PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
LILLI
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IYECHAD
Provider Other First Name:
LILLI
Provider Other Middle Name:
PEREZ
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033327804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LILLI ANN PEREZ, PHD (DBA: FAMILY PACIFIC, INC.)
Provider Second Line Business Mailing Address:
PO BOX 795
Provider Business Mailing Address City Name:
HAGATNA
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-637-5131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLUE OCEAN MEDICAL GROUP (DBA: INTERNATIONAL HEALTH PRO
Provider Second Line Business Practice Location Address:
655 HARMON LOOP ROAD, SUITE 108
Provider Business Practice Location Address City Name:
DEDEDO
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-477-5715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 102L00000X , with the licence number:  S-801 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: IMF-049 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)