Healthcare Provider Details

I. General information

NPI: 1720126378
Provider Name (Legal Business Name): SAMANTHA ELIZABETH JAMES-PEREZ LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ELIZABETH JAMES LPT

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S MYRTLE AVE 1ST FLOOR
MONROVIA CA
91016-3427
US

IV. Provider business mailing address

15734 BLUFFSIDE CT UNIT 189
CHINO HILLS CA
91709-3890
US

V. Phone/Fax

Practice location:
  • Phone: 626-303-1541
  • Fax:
Mailing address:
  • Phone: 909-606-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT30039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: