MEDICARE: MRS. GOLDIE 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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1356809479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GOLDIE PEREZ

Provider Business Mailing Address
First Line	:	3731 E 15TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12235 BEACH BLVD STE 100
Second Line	:
City	:	STANTON
State	:	CA
Zip	:	90680-3943
Country	:	US
Telephone Number	:	714-202-0118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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Directions to “ MRS. GOLDIE PEREZ ” Practice Location

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