Provider Demographics
NPI:1104788553
Name:PEREZ VARELA, ALICIA (AGPCNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:PEREZ VARELA
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 E BROOKDALE PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3501
Mailing Address - Country:US
Mailing Address - Phone:323-313-7449
Mailing Address - Fax:
Practice Address - Street 1:2325 E BROOKDALE PL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3501
Practice Address - Country:US
Practice Address - Phone:323-313-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2025041449363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty