Healthcare Provider Details

I. General information

NPI: 1598744310
Provider Name (Legal Business Name): SANDRA ELIZABETH PEREZ MSN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 10TH ST
RIVERSIDE CA
92501-3522
US

IV. Provider business mailing address

2560 AMY WAY
RIVERSIDE CA
92506-4501
US

V. Phone/Fax

Practice location:
  • Phone: 951-274-7744
  • Fax: 951-274-7754
Mailing address:
  • Phone: 951-369-3381
  • Fax: 951-274-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: