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NPI Code Detail

MEDICARE: CASSIDDY DIVINE PEREZ HIGH SCHOOL DIPLOMA

MEDICARE: CASSIDDY DIVINE PEREZ HIGH SCHOOL DIPLOMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1285567917
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSIDDY DIVINE PEREZ HIGH SCHOOL DIPLOMA
Provider Business Mailing Address
First Line : 1000 PASEO CAMARILLO STE 235
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-0754
Country : US
Telephone Number : 805-383-5566
Fax Number :
Provider Business Practice Location Address
First Line : 1000 PASEO CAMARILLO STE 235
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-0754
Country : US
Telephone Number : 805-383-5566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2026
Last Update Date : 06/03/2026

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Directions to “ CASSIDDY DIVINE PEREZ HIGH SCHOOL DIPLOMA” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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