Provider Demographics
NPI:1558177204
Name:PEREZ, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
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 1:3849 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8700
Mailing Address - Country:US
Mailing Address - Phone:928-278-7706
Mailing Address - Fax:
Practice Address - Street 1:1721 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3620
Practice Address - Country:US
Practice Address - Phone:928-681-2342
Practice Address - Fax:928-757-8314
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program