Provider Demographics
NPI:1316634678
Name:PEREZ, PHEOBE YESENIA
Entity type:Individual
Prefix:
First Name:PHEOBE
Middle Name:YESENIA
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 1:4022 W 184TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4712
Mailing Address - Country:US
Mailing Address - Phone:971-337-2081
Mailing Address - Fax:
Practice Address - Street 1:4022 W 184TH ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4712
Practice Address - Country:US
Practice Address - Phone:971-337-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker