Provider Demographics
NPI:1376799676
Name:PEREZ, ILENIA (PT)
Entity Type:Individual
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First Name:ILENIA
Middle Name:
Last Name:PEREZ
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Gender:F
Credentials:PT
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Mailing Address - Street 1:8302 ESPRESSO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5688
Mailing Address - Country:US
Mailing Address - Phone:661-377-1700
Mailing Address - Fax:661-616-9199
Practice Address - Street 1:1630 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3391
Practice Address - Country:US
Practice Address - Phone:559-256-5200
Practice Address - Fax:559-256-5376
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2019-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT346192251X0800X, 208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT34619OtherLICENSE NUMBER