Provider Demographics
NPI:1861547853
Name:PEREZ, LURANNA S (LISAC)
Entity type:Individual
Prefix:
First Name:LURANNA
Middle Name:S
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 N 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-6004
Mailing Address - Country:US
Mailing Address - Phone:480-313-2264
Mailing Address - Fax:602-253-4710
Practice Address - Street 1:8438 N 55TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-6004
Practice Address - Country:US
Practice Address - Phone:480-313-2264
Practice Address - Fax:602-253-4710
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11644101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)