Healthcare Provider Details

I. General information

NPI: 1316802721
Provider Name (Legal Business Name): JUAN G PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 TELSTAR AVE STE 103
EL MONTE CA
91731-3011
US

IV. Provider business mailing address

4904 ELTON ST
BALDWIN PARK CA
91706-1908
US

V. Phone/Fax

Practice location:
  • Phone: 626-592-9886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: