Healthcare Provider Details

I. General information

NPI: 1700606266
Provider Name (Legal Business Name): BRISA GISSELLE PEREZ-MAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 WALNUT ST
NAPA CA
94559-3101
US

IV. Provider business mailing address

1402 HENDRY CIR
ROCKLIN CA
95765-4222
US

V. Phone/Fax

Practice location:
  • Phone: 707-707-1694
  • Fax:
Mailing address:
  • Phone: 831-256-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: