Healthcare Provider Details

I. General information

NPI: 1114718806
Provider Name (Legal Business Name): JERRY PEREZ DELGADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13222 CHAPMAN AVE
GARDEN GROVE CA
92840-4414
US

IV. Provider business mailing address

11876 STUART DR APT 4
GARDEN GROVE CA
92843-1656
US

V. Phone/Fax

Practice location:
  • Phone: 855-588-1422
  • Fax:
Mailing address:
  • Phone: 657-656-2842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: