Provider Demographics
NPI:1063240463
Name:CAMBRON PEREZ, JUAN (CPT, CNA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:CAMBRON PEREZ
Suffix:
Gender:M
Credentials:CPT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 STATE ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3301
Mailing Address - Country:US
Mailing Address - Phone:805-951-8577
Mailing Address - Fax:805-410-9584
Practice Address - Street 1:625 STATE ST STE 230
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3301
Practice Address - Country:US
Practice Address - Phone:805-951-8577
Practice Address - Fax:805-410-9584
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 171W00000X
CACPT-02166464202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No171W00000XOther Service ProvidersContractor