Healthcare Provider Details

I. General information

NPI: 1407186497
Provider Name (Legal Business Name): JANET PEREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 626-993-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW65674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: