Provider Demographics
NPI:1326122169
Name:PEREZ, MONIQUE YVONNE (DDS)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:YVONNE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S EL MOLINO AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2564
Mailing Address - Country:US
Mailing Address - Phone:626-796-9642
Mailing Address - Fax:626-796-5542
Practice Address - Street 1:175 S EL MOLINO AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2564
Practice Address - Country:US
Practice Address - Phone:626-796-9642
Practice Address - Fax:626-796-9681
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist