Healthcare Provider Details

I. General information

NPI: 1497674857
Provider Name (Legal Business Name): BIANCA SARAI PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BARTON RD STE 104
GRAND TERRACE CA
92313-5037
US

IV. Provider business mailing address

22365 BARTON RD STE 104
GRAND TERRACE CA
92313-5037
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-2899
  • Fax: 909-687-2326
Mailing address:
  • Phone: 909-824-2899
  • Fax: 909-687-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: