Provider Demographics
NPI:1427334424
Name:PEREZ, MARILYN MONIQUE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:MONIQUE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:MONIQUE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 W HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1731
Mailing Address - Country:US
Mailing Address - Phone:559-784-5483
Mailing Address - Fax:559-784-5483
Practice Address - Street 1:222 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1731
Practice Address - Country:US
Practice Address - Phone:559-784-5483
Practice Address - Fax:559-784-5483
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant