Provider Demographics
NPI:1225227671
Name:PERILLA, JESSENIA YVETTE
Entity Type:Individual
Prefix:
First Name:JESSENIA
Middle Name:YVETTE
Last Name:PERILLA
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 1:8337 TELEGRAPH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4957
Mailing Address - Country:US
Mailing Address - Phone:562-862-3644
Mailing Address - Fax:562-865-5244
Practice Address - Street 1:8337 TELEGRAPH RD STE 300
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4957
Practice Address - Country:US
Practice Address - Phone:562-862-3644
Practice Address - Fax:562-865-5244
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW673411041C0700X
390200000X
CAASW1029681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program