Provider Demographics
NPI:1437840527
Name:PEREZ, MELISSA A
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
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 1:1235 E ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2024
Mailing Address - Country:US
Mailing Address - Phone:559-268-6261
Mailing Address - Fax:559-268-7518
Practice Address - Street 1:1235 E ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2024
Practice Address - Country:US
Practice Address - Phone:559-268-6261
Practice Address - Fax:559-268-7518
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35209167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician