Provider Demographics
NPI:1114063815
Name:PEREZ, GINA MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:EIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5604 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-4124
Mailing Address - Country:US
Mailing Address - Phone:661-588-5082
Mailing Address - Fax:661-325-6858
Practice Address - Street 1:8501 BRIMHALL RD
Practice Address - Street 2:SUITE#300
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2252
Practice Address - Country:US
Practice Address - Phone:661-410-2942
Practice Address - Fax:661-410-0135
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily