Healthcare Provider Details

I. General information

NPI: 1083476147
Provider Name (Legal Business Name): KRISTINA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FOWLER AVE APT 238
CLOVIS CA
93611-0686
US

IV. Provider business mailing address

100 FOWLER AVE APT 238
CLOVIS CA
93611-0686
US

V. Phone/Fax

Practice location:
  • Phone: 805-921-5949
  • Fax:
Mailing address:
  • Phone: 805-921-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number6691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: