Healthcare Provider Details

I. General information

NPI: 1740885169
Provider Name (Legal Business Name): MS. DIANA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S MYRTLE AVE STE 100
MONROVIA CA
91016-3406
US

IV. Provider business mailing address

6966 SILVERADO ST
CHINO CA
91710-7490
US

V. Phone/Fax

Practice location:
  • Phone: 626-775-7888
  • Fax:
Mailing address:
  • Phone: 805-889-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB705166
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: