Healthcare Provider Details

I. General information

NPI: 1134887409
Provider Name (Legal Business Name): JENNIFER PEREZCHICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SNOW HILL ST APT 404
FREDERICK MD
21701-7732
US

IV. Provider business mailing address

500 SNOW HILL ST APT 404
FREDERICK MD
21701-7732
US

V. Phone/Fax

Practice location:
  • Phone: 661-709-7308
  • Fax:
Mailing address:
  • Phone: 661-709-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58365
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: