Healthcare Provider Details

I. General information

NPI: 1023807088
Provider Name (Legal Business Name): MS. MIRYAN P PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21732 S VERMONT AVE
TORRANCE CA
90502-2179
US

IV. Provider business mailing address

21732 S VERMONT AVE
TORRANCE CA
90502-2179
US

V. Phone/Fax

Practice location:
  • Phone: 310-781-3412
  • Fax: 310-781-3412
Mailing address:
  • Phone: 310-781-3412
  • Fax: 310-781-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: