Healthcare Provider Details

I. General information

NPI: 1972442465
Provider Name (Legal Business Name): JENNIFER PEREZ PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 FOREST LAWN DR STE 100
LOS ANGELES CA
90068-1027
US

IV. Provider business mailing address

119 W TORRANCE BLVD STE 100
REDONDO BEACH CA
90277-3600
US

V. Phone/Fax

Practice location:
  • Phone: 310-747-4237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: