Provider Demographics
NPI:1962810408
Name:PEREZ, ANA
Entity type:Individual
Prefix:
First Name:ANA
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 1:2973 SANTOS LN APT 305
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7561
Mailing Address - Country:US
Mailing Address - Phone:818-299-1333
Mailing Address - Fax:
Practice Address - Street 1:2973 SANTOS LN APT 305
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-7561
Practice Address - Country:US
Practice Address - Phone:818-299-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00826026282N00000X
CA00250570282N00000X
CAVN279858282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital