MEDICARE: DR. VANESSA C. PEREZ PH.D.

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
1	253J00000X	Foster Care Agency
2	225C00000X	Rehabilitation Counselor
3	103TC0700X	Clinical Psychologist	PSY 24925	CA

General Provider Information

NPI Number	:	1467616151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA C. PEREZ PH.D.

Provider Business Mailing Address
First Line	:	3476 BUCKINGHAM RD
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2021
Country	:	US
Telephone Number	:	909-815-7231
Fax Number	:

Provider Business Practice Location Address
First Line	:	13193 CENTRAL AVE
Second Line	:	SUITE 200
City	:	CHINO
State	:	CA
Zip	:	91710-4179
Country	:	US
Telephone Number	:	909-902-9111
Fax Number	:	909-902-9199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	11/10/2015

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