Healthcare Provider Details

I. General information

NPI: 1215512371
Provider Name (Legal Business Name): KRISTY PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD
ENCINO CA
91436-2203
US

IV. Provider business mailing address

2857 S SANDPIPER AVE
ONTARIO CA
91761-7147
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-1977
  • Fax:
Mailing address:
  • Phone: 818-269-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: