Healthcare Provider Details

I. General information

NPI: 1376475731
Provider Name (Legal Business Name): DIANA CATHERINE PEREZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14624 SHERMAN WAY STE 508
VAN NUYS CA
91405-2289
US

IV. Provider business mailing address

14624 SHERMAN WAY STE 508
VAN NUYS CA
91405-2289
US

V. Phone/Fax

Practice location:
  • Phone: 818-374-6901
  • Fax:
Mailing address:
  • Phone:
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: