Healthcare Provider Details

I. General information

NPI: 1891584843
Provider Name (Legal Business Name): MYRNA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 48TH ST
SACRAMENTO CA
95817-1541
US

IV. Provider business mailing address

79 ACIE LN
FROSTPROOF FL
33843-9717
US

V. Phone/Fax

Practice location:
  • Phone: 916-416-7623
  • Fax:
Mailing address:
  • Phone: 863-241-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: