Healthcare Provider Details

I. General information

NPI: 1376196949
Provider Name (Legal Business Name): MELISSA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 HOWARD RD STE B&C
MADERA CA
93637-5163
US

IV. Provider business mailing address

1179 HAZELNUT LN
MADERA CA
93637-4879
US

V. Phone/Fax

Practice location:
  • Phone: 559-330-2211
  • Fax:
Mailing address:
  • Phone: 559-330-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: