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NPI Code Detail

MEDICARE: MARIANY GAINZA PEREZ

MEDICARE: MARIANY GAINZA PEREZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1134600844
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANY GAINZA PEREZ
Provider Business Mailing Address
First Line : 206 N JACKSON ST STE 202
Second Line :
City : GLENDALE
State : CA
Zip : 91206-4330
Country : US
Telephone Number : 818-241-6780
Fax Number :
Provider Business Practice Location Address
First Line : 5400 SUNCREST DR STE D1
Second Line :
City : EL PASO
State : TX
Zip : 79912-5615
Country : US
Telephone Number : 855-295-3276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2018
Last Update Date : 08/22/2018

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Directions to “ MARIANY GAINZA PEREZ ” Practice Location

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