Healthcare Provider Details

I. General information

NPI: 1043537848
Provider Name (Legal Business Name): JENNY BEATRIZ PEREZ R.D.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY BEATRIZ PEREZ ALEMAN R.D.A

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 WILSHIRE BLVD #1111
LOS ANGELES CA
90025-1123
US

IV. Provider business mailing address

15516 NORDHOFF ST #209
NORTH HILLS CA
91343-3255
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-9933
  • Fax: 310-820-0177
Mailing address:
  • Phone: 818-277-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number75959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: