Provider Demographics
NPI:1124545629
Name:PEREZ, ISIS CHARNEY
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:CHARNEY
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 1:52997 ALBA STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532
Mailing Address - Country:US
Mailing Address - Phone:951-230-1675
Mailing Address - Fax:
Practice Address - Street 1:52997 ALBA ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-1651
Practice Address - Country:US
Practice Address - Phone:951-230-1675
Practice Address - Fax:951-230-1675
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst