Healthcare Provider Details

I. General information

NPI: 1730790635
Provider Name (Legal Business Name): BERENICE MEJIA-PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28191 RESERVOIR AVE
NUEVO CA
92567-9570
US

IV. Provider business mailing address

28191 RESERVOIR AVE
NUEVO CA
92567-9570
US

V. Phone/Fax

Practice location:
  • Phone: 323-702-5661
  • Fax:
Mailing address:
  • Phone: 323-702-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: