Healthcare Provider Details

I. General information

NPI: 1437743754
Provider Name (Legal Business Name): LYZETTE MONIQUE PEREZ-MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 S MAYFLOWER AVE STE 360
MONROVIA CA
91016-5280
US

IV. Provider business mailing address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006-2361
US

V. Phone/Fax

Practice location:
  • Phone: 626-701-4249
  • Fax: 626-737-6034
Mailing address:
  • Phone: 626-701-4249
  • Fax: 626-737-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: