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General NPI Number Information
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NPI Number | 1649092917
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Entity Type | Individual
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Provider Name | THERESE A PEREZ
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1968 W ADAMS BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90018-3515
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Country | US
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Telephone | 310-553-2695
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Fax | 310-553-6718
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Provider Business Mailing Address
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Address Line | 1889 N CERRITOS RD APT 2
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City | PALM SPRINGS
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State | CA
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Zip | 92262-3570
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Country | US
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Telephone | 323-635-4940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5040
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License Number State | CA
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