Provider Demographics
NPI:1043885916
Name:PEREZ, CECILIA JAZMIN
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:JAZMIN
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 1:14816 FRIAR ST APT 203
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2273
Mailing Address - Country:US
Mailing Address - Phone:747-210-2598
Mailing Address - Fax:
Practice Address - Street 1:14816 FRIAR ST APT 203
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2273
Practice Address - Country:US
Practice Address - Phone:747-210-2598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician