Provider Demographics
NPI:1235965013
Name:ALFONSO PEREZ, DAYANA LIEN
Entity type:Individual
Prefix:
First Name:DAYANA
Middle Name:LIEN
Last Name:ALFONSO PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7213
Mailing Address - Country:US
Mailing Address - Phone:239-334-9555
Mailing Address - Fax:
Practice Address - Street 1:3487 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7213
Practice Address - Country:US
Practice Address - Phone:239-334-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator