Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 70615 | ID |
NPI | 1316607864 |
---|---|
Provider Name | Cali Nicole Perez-Verdia |
First Address | Idaho Falls, ID 83406-8302 |
Second Address | Idaho Falls, ID 83404-7573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2021 |
Last Update Date | 26/12/2021 |