Provider Demographics
NPI:1265820740
Name:PEREZ, KARLY
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
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 1:7601 KATELLA AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3100
Mailing Address - Country:US
Mailing Address - Phone:714-470-4487
Mailing Address - Fax:
Practice Address - Street 1:7601 KATELLA AVE
Practice Address - Street 2:APT 5
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3100
Practice Address - Country:US
Practice Address - Phone:714-470-4487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1971224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant