Healthcare Provider Details

I. General information

NPI: 1861261950
Provider Name (Legal Business Name): MELISSA JO PEREZ RN, BSN, CPN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

3338 E PENZANCE LN UNIT C
ORANGE CA
92869-2843
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-8406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number70027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number70027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: