Provider Demographics
NPI:1205227089
Name:PEREZ, KATERINA (NP)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 E SEASIDE WALK # A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5655
Mailing Address - Country:US
Mailing Address - Phone:323-204-6765
Mailing Address - Fax:
Practice Address - Street 1:6213 E SEASIDE WALK # A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5655
Practice Address - Country:US
Practice Address - Phone:323-204-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-14
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner