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General NPI Number Information
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NPI Number | 1790502896
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Entity Type | Individual
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Provider Name | NICHOLAS JOSEPH PEREZ NP
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Gender | Male
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Dates
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Enumeration Date | 09/21/2024
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 5680 KATE WAY UNIT 5
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City | FONTANA
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State | CA
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Zip | 92336-4677
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Country | US
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Telephone | 909-851-7242
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Fax |
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Provider Business Mailing Address
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Address Line | 5680 KATE WAY UNIT 5
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City | FONTANA
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State | CA
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Zip | 92336-4677
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Country | US
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Telephone | 909-851-7242
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95032167
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License Number State | CA
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