Provider Demographics
NPI:1134685605
Name:PEREZ, LESA C
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2881 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1807
Mailing Address - Country:US
Mailing Address - Phone:650-518-1080
Mailing Address - Fax:
Practice Address - Street 1:801 TRAEGER AVE STE 304
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3048
Practice Address - Country:US
Practice Address - Phone:650-742-2000
Practice Address - Fax:877-738-4262
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296228225100000X
CAPT296228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist