Healthcare Provider Details

I. General information

NPI: 1144925538
Provider Name (Legal Business Name): ADRIANA M PEREZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W SUNFLOWER AVE STE 100
SANTA ANA CA
92704-7916
US

IV. Provider business mailing address

2024 E LAINIE ST
WEST COVINA CA
91792-1724
US

V. Phone/Fax

Practice location:
  • Phone: 714-338-1115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95219878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: