Provider Demographics
NPI:1407182876
Name:PEREZ, GRACE DIANE (PSC PARENT PARTNER)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:DIANE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSC PARENT PARTNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 E CLEVELAND AVE
Mailing Address - Street 2:SPACE 183
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-2269
Mailing Address - Country:US
Mailing Address - Phone:559-776-5556
Mailing Address - Fax:
Practice Address - Street 1:83 E SHAW AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7620
Practice Address - Country:US
Practice Address - Phone:559-226-0167
Practice Address - Fax:559-226-1559
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator