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General NPI Number Information
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NPI Number | 1902295322
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Entity Type | Individual
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Provider Name | ELYSE W PEREZ
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Gender | Female
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 17830 ARROW BLVD
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City | FONTANA
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State | CA
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Zip | 92335-4037
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Country | US
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Telephone | 909-356-6439
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Fax | 909-428-6450
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Provider Business Mailing Address
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Address Line | 829 POST ST
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City | REDLANDS
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State | CA
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Zip | 92374-4436
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Country | US
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Telephone | 909-991-3831
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 195424-III
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License Number State | CA
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