MEDICARE: NATHALIE NEGRETE-PEREZ

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1740111319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIE NEGRETE-PEREZ

Provider Business Mailing Address
First Line	:	16025 GAULT ST APT 13
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-4940
Country	:	US
Telephone Number	:	818-619-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	16025 GAULT ST APT 13
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-4940
Country	:	US
Telephone Number	:	818-619-9445
Fax Number	:

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

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ NATHALIE NEGRETE-PEREZ ” Practice Location

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