Provider Demographics
NPI:1154885499
Name:PEREZ, MARICEL V
Entity type:Individual
Prefix:
First Name:MARICEL
Middle Name:V
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 VILLAGE OAKS DR APT 1415
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3778
Mailing Address - Country:US
Mailing Address - Phone:925-818-2508
Mailing Address - Fax:
Practice Address - Street 1:5700 VILLAGE OAKS DR APT 1415
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3778
Practice Address - Country:US
Practice Address - Phone:925-818-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201062278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care