Provider Demographics
NPI:1831811124
Name:PEREZ, ALYSHAA MARIE AGBULOS (FNP)
Entity type:Individual
Prefix:
First Name:ALYSHAA MARIE
Middle Name:AGBULOS
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYSHAA MARIE
Other - Middle Name:
Other - Last Name:AGBULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN FNP-BC
Mailing Address - Street 1:5620 DE LONGPRE AVE APT 715
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8747
Mailing Address - Country:US
Mailing Address - Phone:773-414-3521
Mailing Address - Fax:
Practice Address - Street 1:156 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2504
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350369363LF0000X
CA95026066363LF0000X
IL209025907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily