Healthcare Provider Details

I. General information

NPI: 1649092917
Provider Name (Legal Business Name): THERESE A PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 W ADAMS BLVD
LOS ANGELES CA
90018-3515
US

IV. Provider business mailing address

1889 N CERRITOS RD APT 2
PALM SPRINGS CA
92262-3570
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-2695
  • Fax: 310-553-6718
Mailing address:
  • Phone: 323-635-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: