Healthcare Provider Details

I. General information

NPI: 1154728582
Provider Name (Legal Business Name): REYNA DAYANA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8558 ELBURG ST UNIT C
PARAMOUNT CA
90723-8634
US

IV. Provider business mailing address

8558 ELBURG ST UNIT C
PARAMOUNT CA
90723-8634
US

V. Phone/Fax

Practice location:
  • Phone: 310-733-7448
  • Fax:
Mailing address:
  • Phone: 310-733-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number130215705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: