Provider Demographics
NPI:1568267003
Name:PEREZ LEON, JESUS (RBT-24-365545)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:PEREZ LEON
Suffix:
Gender:
Credentials:RBT-24-365545
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 ROCKPORT CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-9016
Mailing Address - Country:US
Mailing Address - Phone:209-321-8191
Mailing Address - Fax:
Practice Address - Street 1:28403 S CHRISMAN RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-9537
Practice Address - Country:US
Practice Address - Phone:209-321-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-24-365545106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician