Healthcare Provider Details

I. General information

NPI: 1326122169
Provider Name (Legal Business Name): MONIQUE YVONNE PEREZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S EL MOLINO AVE SUITE 3
PASADENA CA
91101-2564
US

IV. Provider business mailing address

175 S EL MOLINO AVE SUITE 3
PASADENA CA
91101-2564
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-9642
  • Fax: 626-796-9681
Mailing address:
  • Phone: 626-796-9642
  • Fax: 626-796-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number43648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: