Provider Demographics
NPI:1003585316
Name:PEREZ, BLANCA VERONICA (CHW)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:VERONICA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 E BURNSIDE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2733
Mailing Address - Country:US
Mailing Address - Phone:971-888-2424
Mailing Address - Fax:
Practice Address - Street 1:1698 SW CHERRY PARK RD
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-1481
Practice Address - Country:US
Practice Address - Phone:971-888-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR104968172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker