Healthcare Provider Details

I. General information

NPI: 1013844190
Provider Name (Legal Business Name): ALEXIS EUNICE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 RIVERSIDE DR
CHINO CA
91710-3439
US

IV. Provider business mailing address

1448 E D ST APT C
ONTARIO CA
91764-5471
US

V. Phone/Fax

Practice location:
  • Phone: 909-627-9638
  • Fax:
Mailing address:
  • Phone: 909-510-3768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: