Provider Demographics
NPI:1871767327
Name:CARTAYA PEREZ, ODALYS (MS)
Entity type:Individual
Prefix:
First Name:ODALYS
Middle Name:
Last Name:CARTAYA PEREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241318
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5318
Mailing Address - Country:US
Mailing Address - Phone:402-460-7963
Mailing Address - Fax:402-763-2894
Practice Address - Street 1:1941 S. 42ND ST.
Practice Address - Street 2:416-N
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-460-7963
Practice Address - Fax:402-460-7963
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026309100Medicaid