Healthcare Provider Details

I. General information

NPI: 1720633720
Provider Name (Legal Business Name): VANESSA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE STE 201
WHITTIER CA
90602-3166
US

IV. Provider business mailing address

234 W BANDERA RD # 325
BOERNE TX
78006-2805
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • 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: