Healthcare Provider Details

I. General information

NPI: 1821385626
Provider Name (Legal Business Name): DIANE PEREA-PEREZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SHAW AVE
CLOVIS CA
93612-3900
US

IV. Provider business mailing address

900 SHAW AVE
CLOVIS CA
93612-3900
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-5697
  • Fax: 559-297-5697
Mailing address:
  • Phone: 559-297-5697
  • Fax: 559-297-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: