Provider Demographics
NPI:1306507231
Name:PEREZ, LILIA REYES
Entity type:Individual
Prefix:
First Name:LILIA
Middle Name:REYES
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 1:116 BRIARTHORNE CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4217
Mailing Address - Country:US
Mailing Address - Phone:916-880-3198
Mailing Address - Fax:949-317-4609
Practice Address - Street 1:116 BRIARTHORNE CT
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-4217
Practice Address - Country:US
Practice Address - Phone:916-880-3198
Practice Address - Fax:949-317-4609
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)