Healthcare Provider Details

I. General information

NPI: 1710794706
Provider Name (Legal Business Name): GABRIEL GERARDO PEREZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6800
  • Fax: 559-353-6813
Mailing address:
  • Phone: 559-353-6800
  • Fax: 559-353-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: