Provider Demographics
NPI:1962119594
Name:PERAZA, NALANNY VICTORIA
Entity type:Individual
Prefix:
First Name:NALANNY
Middle Name:VICTORIA
Last Name:PERAZA
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 1:1408 PALOMINO AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2572
Mailing Address - Country:US
Mailing Address - Phone:909-276-9104
Mailing Address - Fax:
Practice Address - Street 1:8595 CALAVERAS AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4215
Practice Address - Country:US
Practice Address - Phone:909-276-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty