MEDICARE: HEATHER 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	225XG0600X	Gerontology Occupational Therapist	4990	CA

General Provider Information

NPI Number	:	1972142826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER PEREZ

Provider Business Mailing Address
First Line	:	612 DEL ORO PL
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-0423
Country	:	US
Telephone Number	:	530-574-5886
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 ESTATES DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-9711
Country	:	US
Telephone Number	:	707-432-1218
Fax Number	:

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

Provider Enumeration Date	:	12/24/2019
Last Update Date	:	12/24/2019

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Directions to “ HEATHER PEREZ ” Practice Location

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