Provider Demographics
NPI:1407225105
Name:PEREZ, JONAE BRIANNE (MPH, RD)
Entity Type:Individual
Prefix:
First Name:JONAE
Middle Name:BRIANNE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E ANGELENO AVE
Mailing Address - Street 2:APT. 201
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3023
Mailing Address - Country:US
Mailing Address - Phone:626-793-7350
Mailing Address - Fax:626-793-7341
Practice Address - Street 1:620 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1220
Practice Address - Country:US
Practice Address - Phone:626-793-7350
Practice Address - Fax:626-793-7341
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86009819133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered