Provider Demographics
NPI:1043537848
Name:PEREZ, JENNY BEATRIZ (RDA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:BEATRIZ
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:BEATRIZ
Other - Last Name:PEREZ ALEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:15516 NORDHOFF ST
Mailing Address - Street 2:#209
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3255
Mailing Address - Country:US
Mailing Address - Phone:818-277-4498
Mailing Address - Fax:
Practice Address - Street 1:12121 WILSHIRE BLVD
Practice Address - Street 2:#1111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1123
Practice Address - Country:US
Practice Address - Phone:310-820-9933
Practice Address - Fax:310-820-0177
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75959126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant