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NPI Code Detail

MEDICARE: JESENIA PEREZ

MEDICARE: JESENIA 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 TechnicianBACB337139IL

General Provider Information

NPI Number : 1619410511
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESENIA PEREZ
Provider Business Mailing Address
First Line : 2796 CRANSTON CIR
Second Line :
City : YORKVILLE
State : IL
Zip : 60560-4613
Country : US
Telephone Number : 708-691-3924
Fax Number :
Provider Business Practice Location Address
First Line : 452 N EOLA RD STE A
Second Line :
City : AURORA
State : IL
Zip : 60502-9110
Country : US
Telephone Number : 630-999-0401
Fax Number : 630-423-9669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2016
Last Update Date : 11/23/2016

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Directions to “ JESENIA PEREZ ” Practice Location

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