Healthcare Provider Details

I. General information

NPI: 1649621608
Provider Name (Legal Business Name): RACHEL PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11337 183RD ST
CERRITOS CA
90703-5434
US

IV. Provider business mailing address

11337 183RD ST
CERRITOS CA
90703-5434
US

V. Phone/Fax

Practice location:
  • Phone: 562-809-2167
  • Fax:
Mailing address:
  • Phone: 562-809-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA 3247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: