Provider Demographics
NPI:1619559002
Name:PEREZ, EDER J (LAC)
Entity type:Individual
Prefix:
First Name:EDER
Middle Name:J
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ESTRELLA PKWY STE B2
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4136
Mailing Address - Country:US
Mailing Address - Phone:602-661-0200
Mailing Address - Fax:
Practice Address - Street 1:500 N ESTRELLA PKWY STE B2 #447
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338
Practice Address - Country:US
Practice Address - Phone:602-661-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor