Provider Demographics
NPI: | 1225037666 |
---|---|
Name: | PEREZ, SYLVIA IRMA (PMHNP) |
Entity type: | Individual |
Prefix: | |
First Name: | SYLVIA |
Middle Name: | IRMA |
Last Name: | PEREZ |
Suffix: | |
Gender: | F |
Credentials: | PMHNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 101 S CUCHARAS MOUNTAIN CT |
Mailing Address - Street 2: | |
Mailing Address - City: | LIVERMORE |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80536-8617 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-999-4582 |
Mailing Address - Fax: | 970-678-0273 |
Practice Address - Street 1: | 101 S CUCHARAS MOUNTAIN CT |
Practice Address - Street 2: | |
Practice Address - City: | LIVERMORE |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80536-8617 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-999-4582 |
Practice Address - Fax: | 970-678-0273 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-19 |
Last Update Date: | 2025-04-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | C-APN.0100324-C-NP | 363LP0808X, 363LP0808X |
TX | AP110195 | 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 142137201 | Medicaid | |
TX | 142137203 | Medicaid | |
TX | 142137204 | Other | CSHCN |